Jacquet erosive dermatitis associated with commercial barrier cream

Jacquet erosive dermatitis (JED) is a rare, severe form of napkin dermatitis associated with friction and irritant exposure in the napkin area. The condition typically causes erosions and erythematous punched-out ulcerations. We present two cases of JED in infants associated with the use of a common brand barrier cream Curash. This appeared to present following a change of several active ingredients.

Fibreglass dermatitis: diagnostic challenges and occupational interventions

Fibreglass dermatitis is a common occupationally acquired irritant contact dermatitis, where small spicules of fibreglass lodging in the stratum corneum result in mechanical irritation. We present two patients, an air-conditioning ducting worker and an injection moulding machine operator, who both presented with generalized pruritus. In the first case, polarized microscopy of a skin biopsy specimen demonstrated rare small spicules, with a diameter of 1 µm, lodged in the stratum corneum. In the second case, skin tape stripping demonstrated fibreglass particles, not found on skin biopsy. Proper work practices, personal hygiene and use of impervious barrier materials were recommended. The first patient did not return for follow-up, and the second patient's dermatitis resolved after handling of fibreglass-containing material was eliminated from his job scope. In conclusion, we present two cases of fibreglass dermatitis to illustrate the challenges in diagnosis and highlight strategies for prevention.

Oleic acid exhibits an expressive anti-inflammatory effect in croton oil-induced irritant contact dermatitis without the occurrence of toxicological effects in mice

ETHNOPHARMACOLOGICAL RELEVANCE

Cutaneous inflammatory diseases, such as irritant contact dermatitis, are usually treated with topical corticosteroids, which cause systemic and local adverse effects limiting their use. Thus, the discovery of new therapeutic alternatives able to effectively treat skin inflammatory disorders, without causing adverse effects, is urgently needed.

AIM OF THE STUDY

To investigate the topical anti-inflammatory effect of oleic acid (OA), a monounsaturated fatty acid, into Pemulen® TR2-based semisolid dosage forms, employing a croton oil-induced irritant contact dermatitis model in mice.

MATERIALS AND METHODS

Male Swiss mice were submitted to skin inflammation protocols by acute and repeated applications of croton oil. The anti-inflammatory activity of Pemulen® TR2 hydrogels containing OA was evaluated by assessing oedema, inflammatory cell infiltration, and pro-inflammatory cytokine IL-1β levels. The mechanisms of action of OA were evaluated using cytokine IL-1β application or pretreatment with the glucocorticoid antagonist mifepristone. Possible toxic effects of OA were also assessed.

RESULTS

Pemulen® TR2 3% OA inhibited the acute ear oedema [maximal inhibition (I_max) = 76.41 ± 5.69%], similarly to dexamethasone (I_max = 84.94 ± 2.16%), and also inhibited ear oedema after repeated croton oil application with I_max = 85.75 ± 3.08%, similar to dexamethasone (I_max = 81.03 ± 4.66%) on the day 7 of the experiment. Croton oil increased myeloperoxidase activity, which was inhibited by Pemulen® TR2 3% OA (I_max = 71.37 ± 10.97%) and by 0.5% dexamethasone (I_max = 96.31 ± 3.73%). Pemulen® TR2 3% OA also prevented the increase in pro-inflammatory cytokine IL-1β levels induced by croton oil (I_max = 94.18 ± 12.03%), similar to 0.5% dexamethasone (I_max = 87.21 ± 10.58%). Besides, both Pemulen® TR2 3% OA and 0.5% dexamethasone inhibited IL-1β-induced ear oedema with an I_max of 80.58 ± 2.45% and 77.46 ± 1.92%, respectively. OA and dexamethasone anti-inflammatory effects were prevented by 100% and 91.43 ± 5.43%, respectively, after pretreatment with mifepristone. No adverse effects were related to Pemulen® TR2 3% OA administration.

CONCLUSIONS

OA demonstrated anti-inflammatory efficacy similar to dexamethasone, clinically used to treat skin inflammatory conditions, without presenting adverse effects.

In Vivo Reflectance Confocal Microscopy: Emerging Role in Noninvasive Diagnosis and Monitoring of Eczematous Dermatoses

Dermatologic diagnosis and monitoring have been dependent largely on visual grading. A skin biopsy is performed in case of diagnostic uncertainty, but can be traumatic, and results are delayed due to time for specimen transport and processing. Biopsies also destroy specimens, prohibiting lesion evolution monitoring. In vivo reflectance confocal microscopy (RCM) offers a diagnostic alternative to skin biopsy. RCM captures real-time, high-resolution images, and has been piloted for the evaluation of various dermatologic conditions. Identification of unique RCM features may distinguish dermatoses with similar clinical morphologies. Allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD) are diagnosed by patch testing that currently uses a subjective scoring system. RCM has increasingly been studied for early detection and severity grading of CD. Common RCM features shared by ACD and ICD are stratum corneum disruption, vesicle formation, exocytosis, spongiosis, and parakeratosis. Features unique to ACD are vasodilation, increased epidermal thickness, intercellular edema, and acanthosis. Features unique to ICD are detached corneocytes and targetoid keratinocytes. This review summarizes the use of RCM in evaluating contact eccematous conditions and aims to spark future research and interest in this promising tool.

Hand Dermatitis: Pathology, Diagnosis, and Management

Hand dermatitis is a common skin disorder that can negatively impact a patient's daily life and occupation. The necessity and frequency of hand use can expose the overlying skin to irritation, trauma, and observation from others. This can make hand dermatitis irritating to active hands and difficult to treat, as irritant exposure is often difficult to avoid. Due to the variable degrees of presentations of hand dermatitis, it is essential for dermatologists to adequately recognize the variable presentation, establish a definitive diagnosis, and develop an appropriate treatment. This review explores the pathogenesis, clinical types, diagnosis methods, treatment, and prognosis of hand dermatitis. (SKINmed. 2019;17:30-34).

[Vulval dermatitis: localized condition--serious problem]

An overview of the literature of the dermatitis of the vulva is presented. The etiology, epidemiology, clinical manifestations, diagnosis, pathological diagnosis, treatment, and prevention of contact, allergic-contact, atopic, and seborrheic dermatitis of the vulva are described in details. Lichen simplex chronicus is additionally described as complication of chronic itching dermatitis.

[Contact dermatitis: an approach used by a medical officer]

The article deals with contact dermatitis issues, that are of interest not only for dermatologists and specialists in professional pathology, but as well as for general practitioners. Issues of contact dermatitis classification, pathogenic peculiarities of the disease main forms and their basic causes are discussed. Clinical manifestations of irritative and allergic contact dermatitis are described in detail, aspects of differential diagnostics analysed. A detailed consideration is given to allergic diagnostics of contact dermatitis using application test-systems with the most common contact allergens. Main principles of contact dermatitis treatment are outlined in the article. The necessity of a complex approach to this disease therapy that requires not only external therapy, but the compliance with an appropriate treatment regimen, diet as well as application of a particular system therapy is shown. Recommendations for contact dermatitis prophylaxis are given.

Erythema multiforme-like irritant contact dermatitis after application of an antiscabies treatment

We describe the case of an irritant contact dermatitis due to an antiscabies treatment in a man who presented to our clinic with an important cutaneous reaction with many hemorrhagic, "target" erythema multiforme-like lesions, as the result of an acute toxic insult of the skin by permethrin 5%. This is a possible, but very uncommon symptom of non-eczematous contact dermatitis and an unusual drug causing the acute hypersensitivity reaction typical of erythema multiforme.

Effects of topical corticosteroid and tacrolimus on ceramides and irritancy to sodium lauryl sulphate in healthy skin

The skin barrier, located in the stratum corneum, is influenced mainly by the lipid and protein composition of this layer. In eczematous diseases impairment of the skin barrier is thought to be of prime importance. Topical anti-inflammatory drugs and emollients are the most widely used eczema treatments. The aim of this study was to examine the effects of topically applied corticosteroid, tacrolimus and emollient on stratum corneum lipids and barrier parameters. Nineteen healthy volunteers participated in the study. Both forearms of the subjects were divided into four areas, which were treated twice daily for one week with betamethasone, tacrolimus, emollient, or left untreated, respectively. After one week each area was challenged with a 24 h sodium lauryl sulphate patch test. The lipids were collected using the cyanoacrylate method and evaluated by high performance thin layer chromatography. For evaluation of the skin barrier, transepidermal water loss, erythema and electrical capacitance were measured. The ceramide/cholesterol ratio was increased in betamethasone- (p = 0.008) and tacrolimus-treated (p = 0.025) skin compared with emollient-treated skin. No differences in ceramide subgroups were found between treatment regimes. Pretreatment with betamethasone (p = 0.01) or with tacrolimus (p = 0.001) causes a decreased inflammatory response to sodium lauryl sulphate compared with emollient. In conclusion, treatment with betamethasone and tacrolimus has a positive effect on the ceramide/cholesterol ratio and susceptibility to irritant reaction compared with an emollient.

Pseudoverrucous irritant peristomal dermatitis with an histological pattern of nutritional deficiency dermatitis

Pseudoverrucous papules and nodules (PPN) is an uncommon complication, mainly reported in the diaper area. It is thought to be a manifestation of chronic irritant contact dermatitis that develops as a result of prolonged exposure to liquid stool and/or urine. We report a case of a peristomal PPN with a histolopathology simulating a nutritional deficiency dermatitis.

Soccer shin guard reactions: allergic and irritant reactions

In spite of the worldwide popularity of soccer among youth and the common requirement of the use of protective shin guards, reports of allergy to shin guards is sparse. This is surprising in light of the fact that this equipment is often made of materials that are reported to cause allergies, and that friction and moisture from the use of these shin guards during the sport would seem to predispose soccer players to the development of an allergic response. We present eight patients that presented for evaluation of dermatitis under their shin guards--some of which had allergy to their shin guards and some of which were diagnosed as having an irritant reaction.

Natural killer T cells expressing IFN-gamma and IL-4 in lesional skin of atopic eczema

BACKGROUND

The inflammation of atopic eczema (AE) is orchestrated not only by T cells predominantly but also B cells, eosinophils and dendritic cells. Recently, a role of invariant natural killer T (NKT) cells has been reported in bronchial asthma and allergy. Natural killer T cells express a restricted repertoire of T-cell receptor alpha/beta and produce interferon (IFN)-gamma and/or interleukin (IL)-4 upon activation.

AIM OF THE STUDY

To determine the presence of NKT cells in lesional AE skin in comparison with other eczematous disorders and to analyse their cytokine expression.

METHODS

Immunofluorescence stainings were carried out using antibodies recognizing NKT cells, CD3+ and CD4+ cells, IFN-gamma and IL-4.

RESULTS

Natural killer T cells have been detected in small numbers in the majority of AE specimens as well as in atopy patch test (APT) reactions, allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD). In AE, the proportion of NKT cells among CD3+ cells was approximately 5%. NKT cells expressed both IFN-gamma and IL-4 in AE, APT and ACD but predominantly IFN-gamma in ICD.

CONCLUSION

Natural killer T cells are part of the inflammatory infiltrate of AE as well as APT, ACD and ICD, suggesting a pathogenic role of NKT cells in eczematous skin disorders. The pattern of IFN-gamma and IL-4 cytokine expression by NKT cells varied depending on the type of eczematous disease.

Skin irritation and histopathologic alterations in rats exposed to lightstick contents, UV radiation and seawater

Lightsticks are fishing gadgets that provide fluorescent lighting when two organic solutions are mixed. In NE Brazil, low-income coastal residents ignore their conventional use and collect lightsticks stranded on beaches. The lightstick solution is then used for various purposes, including direct human skin exposure. We assessed the reactions and possible cell damages on the skin of Wistar rats. Animals were exposed to lightstick contents, UV radiation and/or seawater. Lightstick exposure led to erythemas, oedemas and vesicles. Histopathologic alterations included proliferation of the epidermis and inflammatory infiltrates. In spite of the short time of experimentation (4 days), the rats exposed to the lightstick content alone and together with UV radiation and/or seawater provided evidence of irritation/alteration reactions that may evolve into skin cancer. Our results demonstrated a few of the potential problems associated with lightstick dumping into the ocean and highlight the need for further investigations about this new type of marine pollutant.

Contact dermatitis caused by sunless tanning treatment with dihydroxyacetone in hairless descendants of Mexican hairless dogs

Dihydroxyacetone (DHAT) is a color additive that is added to sunless tanning products to produce an artificial tan. Although this agent has been used extensively as safe sunless tanning, no published data are available to judge whether the abuse of DHAT causes a potential hazard to the human skin. The purpose of this study was to clarify whether frequent treatment with DHAT solutions had a deleterious effect on the wide skin surface of hairless descendants of Mexican hairless dogs. The skin reactions to the DHAT-treatment were investigated by daily clinical observations and histopathological examinations (21 and 42 days after the beginning of the DHAT-treatment). Clinical observations showed that skin color changes were apparent within 6 h after the first treatment with 5% DHAT solutions, with maximal darkening between 12 and 24 h. Twenty-one days after the beginning of the treatment with 5% DHAT solutions, the skin developed irritant dermatitis, and then the skin lesions gradually became severe during this study. Histopathological examinations showed entire epidermal thickening, 21 days after the beginning of the treatment with 5% DHAT solutions. Forty-two days after the beginning of the treatment with 5% DHAT solutions, the skin exhibited remarkable epidermal degeneration (hyperplastic and dyskeratotic changes) and moderate inflammatory reactions in the dermis. In severe dermatitic sites, I found focal epidermal necrosis or interepidermal blister formation beneath the thickened parakeatotic corneum. Throughout this study, there were no clinical and histopathological changes in the sites treated with vehicle alone. These results revealed that the skin coloring generated by frequent wide treatments with DHAT caused severe contact dermatitis which was associated with the damaged stratum corneum.

Paederus dermatitis in Najaf province of Iraq

OBJECTIVE

To assess the different epidemiological and clinical features of Paederus dermatitis in Najaf province.

METHODS

This prospective observational study, including the clinical assessment of 87 patients with definitive diagnosis of Paederus dermatitis, who presented to a dermatology clinic in the Najaf province of Iraq, was carried out from April 2006 to April 2007.

RESULTS

The peak time of presentation was in May, and the face and neck were the most common sites of involvement. Frightening appearance of the lesion is the main cause that brought the patients to the hospital. The symptoms of burning and stinging were of mild degree. Clinically, the most common presentation comprised geographic and linear erythematous plaques with micropustules. Kissing lesions were seen in 5.7% of cases. Periorbital involvement was recorded in 16.1% of the cases.

CONCLUSION

Paederus dermatitis is a common skin condition in Najaf province. The awareness of this condition among the medical practitioners will aid in the early diagnosis and prompt treatment of the disease. Also, overall public awareness can help decrease the incidence of Paederus dermatitis.

An outbreak of Paederus dermatitis in a primary school, Terengganu, Malaysia

Outbreaks of Paederus dermatitis have been reported in several Asia-Pacific countries when rove beetles (genus Paederus) are accidentally brushed or crushed on the skin, releasing haemolymph pederin. An investigation was conducted in a school to ascertain the causative agent, establish the case definition, epidemiological characterisation of cases, entomological and environmental survey and data analysis. This outbreak occurred among 36 schoolchildren attending a night tuition class conducted by their teacher. Dermatitis developed within 24 hours in 33/37 (89.2%) cases with itchiness as the first presenting symptom in 87.9% of cases. Periorbital oedema and erythematous-vesicular plaques on the upper extremities were seen in 57.6% of cases, on the back (36.4%) and on the nape (24.2%). Signs and symptoms were present 12 hours after exposure in 66.7% of cases with burning sensation within four hours in 9.1%. Seven cases received out-patient treatment. Thirty cases (90.9%) recalled exposure to Paederus fuscipes with 28 (84.8%) cases admitting crushing or brushing the insects. (Relative risk = 2.2; 95% CI: 1.2; 4.2). The school with fluorescent lighting, was located next to paddy fields. P. fuscipes was easily found in the paddy fields and along the school corridors. This strongly supports it as the likely causative agent for the dermatitis. Boarding the ventilation panes and use of insect spray were successfully implemented to control the outbreak. Increased awareness of this condition is important to prevent misdiagnosis.

Self-treatment with bleach by a Latino farmworker

Skin disease is common among migrant Latino farmworkers. These workers rarely use formal health care services but commonly engage in self-treatment of their skin disease. We present a patient with dermatitis who self-treated with bleach. This patient illustrates a common practice that exacerbates skin disease and sheds light on social and cultural factors of which health care providers serving this community should be aware.

How the skin reacts to environmental factors

The skin is one of the main points of contact with the environment. Usually, interactions between skin and environmental factors are harmonious. But sometimes, the skin barrier is modified (dry or greasy skin) or skin inflammation can occur (irritated, reactive, allergic or atopic skin).

Airborne irritant contact dermatitis and conjunctivitis after occupational exposure to chlorothalonil in textiles

Chlorothalonil (tetrachloro-1,3-benzenedicarbonitrile, CAS 1897-45-6) is a pesticide that has been on the market for many years. It is used as a fungicide in agriculture, horticulture, and floriculture; as a wood preservative; and in paint. We report an epidemic of airborne irritant contact dermatitis, conjunctivitis, and upper airway complaints among seamstresses in a Portuguese trailer tent factory, which we attribute to chlorothalonil. All exposed workers had work-related skin symptoms. After patch testing, we showed that none of these were of allergic origin. Instead of allergic reactions, we noticed a delayed type of irritation after 72 hr to chlorothalonil and to the textile extracts containing high concentrations of chlorothalonil. Although allergic and irritant contact dermatitis from chlorothalonil has been described before, this is, as far as we know, the first time that a delayed type of dermatitis, conjunctivitis, and upper airway irritation after exposure to chlorothalonil in tent-cloth is described.

Metallothionein I and II gene knock-out mice exhibit reduced tolerance to 24-h sodium lauryl sulphate patch testing

BACKGROUND

Metallothioneins (MTs) are a group of proteins widely distributed in tissues regulating metal metabolism, scavenging free radicals, and taking part in immunological reactions. Knockout mice for MT genes I and II (MT(-/-)) exhibit reduced tolerance to ultraviolet B injury in vivo. Upregulation of MT proteins can be found at positive allergy patch-test sites; however, the role of MTs in skin irritation has not been investigated.

AIM

To evaluate the role of MT genes in sodium lauryl sulphate (SLS)-induced skin irritation. SLS is a well-known model irritant in the study of experimental irritant contact dermatitis.

METHODS

Skin irritation was induced in mice by applying closed-patch testing of 2.5%, 5%, 7.5% and 10% SLS in distilled water on the right dorsal skin of MT(-/-) mice for 24 h. Skin irritation was evaluated visually and by the number of infiltrated inflammatory cells in SLS-irritated skin. Homozygous wild-type mice with intact MT genes (MT(+/+)) tested at the same time served as controls.

RESULTS

MT(-/-) mice showed a much higher degree of skin inflammation than did MT(+/+) mice. Numbers of infiltrated inflammatory cells were 312.8 +/- 50.9 vs. 136.2 +/- 13.1 for 2.5%, 430.2 +/- 49.3 vs. 242.6 +/- 28.6 for 5%, 540.2 +/- 28.4 vs. 437.6 +/- 22.2 for 7.5%, and 690.6 +/- 31.0 vs. 559.0 +/- 37.8 for 10% SLS in MT(-/-) and MT(+/+) mice, respectively (P < 0.05, Mann-Whitney U test).

CONCLUSIONS

These results clearly suggest that the MTI and MTII genes may play an important protective role in SLS irritation. It would be valuable to study whether topical MTs can prevent or treat skin irritation.

An outbreak of Paederus dermatitis in a suburban hospital in South India: a report of 123 cases and review of literature

BACKGROUND

Paederus dermatitis is a peculiar irritant contact dermatitis caused when beetles of the genus Paederus (often called rove beetles) are crushed on the skin, releasing the vesicant pederin. The dermatitis is most frequently seen in regions with a hot, tropical climate.

METHODS

We describe 123 patients who presented to our dermatology department at a suburban teaching hospital located in Tamilnadu, South India, known for its long, hot summers. Ours was a 1-year prospective study (January 2005 to December 2005).

RESULTS

The peak time of presentation was during April. The mean duration of lesions before presentation was 2.7 days. The neck and arms were the most common sites of involvement. Male patients outnumbered female patients in our study (males 65%, females 35%). The mean age of patients was 23.4 years. Clinically, the most common presentation consisted of linear, geographic, erythematous plaques with a "burnt" appearance. In 61% of patients, more than one lesion was present. Vesicles were seen in 33.3% of patients and pustules in 4.9% of patients. "Kissing lesions" were seen in 1.6% of patients. Periorbital involvement occurred in 4.9% of patients. The majority of patients were students residing in various hostels in our campus, within 1 km of rice fields.

LIMITATIONS

Species identification of the Paederus beetles was not done. In addition, skin biopsy of the lesions was not done and no histopathologic examination was performed.

CONCLUSION

An outbreak of paederus dermatitis can occur in tropical regions. Awareness of the condition and its clinical features will prevent misdiagnosis. Simple preventive measures can be undertaken based on the behavioral pattern of this nocturnal beetle.

Noninvasive evaluation of allergic and irritant contact dermatitis by in vivo reflectance confocal microscopy

BACKGROUND

The clinical differentiation of allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD) is often difficult to accomplish. Reflectance-mode confocal microscopy (RCM) is an imaging technique that has previously been used to examine ACD and ICD noninvasively in vivo.

OBJECTIVE

To determine characteristic features of ACD and ICD and their kinetic evolution over time. Ethnic susceptibility to contact irritants such as sodium lauryl sulfate and Ivory dishwashing liquid was evaluated noninvasively, and the sensitivity and specificity of RCM parameters were analyzed in a clinical context and in reference to patch testing.

METHODS

Subjects were patch-tested with allergens, irritants, and controls. Clinical scoring and RCM evaluation were performed at various time points, assessing stratum corneum (SC) disruption, spongiosis, exocytosis, vesicle formation, and epidermal thickness.

RESULTS

RCM features of both ACD and ICD include spongiosis, exocytosis, vesicle formation, and blood vessel dilatation. SC disruption, epidermal necrosis, and hyperproliferation are hallmarks of ICD whereas ACD more typically presents with vesicle formation. Patients with ICD showed a more rapid recovery than those with ACD. When tested with Ivory soap at selected concentrations, Caucasians, when compared to African Americans, showed significantly lower clinical thresholds for ICD and features that were more severe.

CONCLUSIONS

RCM may be a promising new technology for longitudinal noninvasive studies of contact dermatitis (CD). Using a diagnostic algorithm and those parameters with high sensitivity for CD, RCM may facilitate the differentiation of acute ACD and ICD. RCM can reliably visualize cutaneous changes at subclinical degrees of CD, which suggests a possible role for RCM as an adjunctive tool in CD diagnosis. The results of this pilot study also indicate ethnic differences in the response to contact irritants. However, further studies are needed to substantiate the relevance and clinical applicability of our findings.

Comparison of objective and sensory skin irritations of several cosmetic preservatives

There are many cosmetic ingredients, such as preservatives and fragrances, known to elicit adverse effects. The aim of this study was to investigate the side-effects of cosmetic preservatives, by evaluating objective and subjective skin irritation. The method comprised of 2 parts. In part 1, we tried to compare 24-hr patch test results with the sensory irritation potential of several preservatives. In part 2, skin cumulative irritation test for 21 days and sensory irritation test were performed to compare various combinations of preservatives in 4 types of formulations. Our data showed that methylparaben, ethylparaben, propylparaben, butylparaben, phenoxyethanol (PE) and chlorphenesin (CPN) have similar objective skin irritation potential at the minimal inhibitory concentration of each preservative, but CPN has higher potential than other preservatives in subjective irritation. Sensory irritation of preservatives changed according to formulation type, and PE combined with CPN highly increased irritation. There was correlation between antimicrobial activity and skin objective irritation but not sensory irritation. Influence on skin sensory irritation varies with the combination of preservatives. Therefore, for the development of new preservatives and cosmetics, it is important to evaluate skin sensory irritation of preservatives used in cosmetic products according to the type of formulations.

Occupational skin diseases in Singapore 2003?2004: an epidemiologic update

In this 2-year retrospective epidemiologic study of occupational skin disease in Singapore, there were 125 patients with occupational contact dermatitis. The mean age of patients was 33.8 years, with a male to female ratio of 5.3:1. Irritant contact dermatitis made up 62.4% of all cases, whereas allergic contact dermatitis constituted 37.6%. Wet work/detergents, oil/grease and solvents remained the 3 commonest irritants. There was also a significant increase in representation of workers from the food/catering industry in our study.

The effect of adhesive dressing edges on cutaneous irritancy and skin barrier function

OBJECTIVE

To assess the effect of repeated application and removal of adhesive edges from wound-care products on cutaneous irritancy and barrier function in normal volunteer subjects.

METHOD

This was a study using a 'repeat-insult patch test'. Adhesive edges from six commonly used wound-care products were applied continuously to the same site (six applications over a 14-day period) in 30 normal volunteer subjects. The test sites were assessed clinically before product reapplication using established ranking scales for cutaneous erythema. The cumulative irritancy score (CIS) for each test site was determined by adding the erythema scores at days 3, 5, 8, 10, 12 and 15. At the study end the barrier function of each test site was assessed by measuring transepidermal water loss (TEWL).

RESULTS

The CIS showed that the products fall into two distinct groups, with Mepilex, Tielle and Allevyn giving low scores and Biatain, Comfeel and DuoDERM higher scores. Statistical analysis indicated significant differences (p < 0.05) between Mepilex and Biatain, Mepilex and Comfeel, Mepilex and DuoDERM, Tielle and Biatain, Allevyn and Biatain. The mean TEWL values also indicated that the products fall into two distinct groups: Mepilex, Tielle and Allevyn with low mean values close to that of normal adjacent back skin and Biatain, Comfeel and DuoDERM with much higher mean values. Statistical analysis indicated that Mepilex, Tielle and Allevyn were not significantly different from normal skin (p < 0.05), whereas Biatain, Comfeel and DuoDERM were significantly higher than normal skin and the other products tested.

CONCLUSION

The results show clear differences between products; the clinical scores and TEWL measurements indicate that the products fall into two distinct groups. This novel approach seems able to discriminate between adhesive borders and may be useful during product development and in selecting products for clinical trials.

Contact and primary irritant dermatitis of the nail unit diagnosis and treatment

Contact dermatitis of the nail unit is not rare. The most common allergens are found in nail cosmetics such as enamel, sculptured nails, and preformed plastic tips. Toluene sulfonamide formaldehyde resin, acrylates, and ethylcyanoacrylate are the most common allergens. Along with a proper clinical history focusing on nail practices, a thorough understanding of the common allergens and patch testing are necessary to diagnose contact dermatitis. A discussion of the common allergens and irritants relevant to the nail unit will be presented.

Role of protective gloves in the causation and treatment of occupational irritant contact dermatitis

Irritant contact dermatitis of the hands is a significant occupational problem. Management primarily involves cessation of exposure to hazardous substances. Protective gloves can reduce or eliminate exposure of the hands to hazardous substances if used correctly, but if not selected and used correctly, protective gloves can actually cause or worsen irritant contact dermatitis of the hands by increasing exposure of the hands to hazardous chemicals. We present two cases of occupational irritant contact dermatitis of the hands caused by incorrect use of protective gloves. Glove failure can occur by penetration, permeation, or contamination, and all 3 mechanisms were operative in these cases. These cases demonstrate that correct use of gloves is at least as important as selection of gloves made of the appropriate material. By understanding mechanisms of glove failure, clinicians can make more appropriate recommendations for the selection and use of protective gloves in the workplace.

Anti-irritants I: dose–response in acute irritation

The term 'anti-irritant' (AI) was coined in 1965 by Goldemberg to describe a diverse group of topical product ingredients, which were able to reduce the irritation potential of other more irritating ingredients in the same product. 'AIs' are being added to cosmetic formulations in order, allegedly, to benefit tolerability of the products and allow claims such as 'soothing' and 'healing' ingredients. Limited documentation in favour of the efficacy of AIs is published. We studied the dose-related effect of 4 alleged AIs (nifedipine, (-)-alpha-bisabolol, canola oil and glycerol) on experimentally induced acute irritation in healthy volunteers. Each AI was used in 3 concentrations. Acute irritation was induced by occlusive tests with 1% sodium lauryl sulfate and 20% nonanoic acid in N-propanol. The irritant reactions were treated twice daily with AI-containing formulations from the time of removal of the patches. Evaluation of skin irritation and efficacy of treatments were performed daily for 4 days using clinical scoring, evaporimetry (transepidermal water loss), hydration measurement and colourimetry. Only glycerol showed dose-response and effects potentially better than no treatment. There was no significant effect and no difference between the three other AIs.

Anti-irritants II: efficacy against cumulative irritation

So-called anti-irritants (AI) are widely used in cosmetic formulations, with the aim of reducing irritation from substances in the formulation. It may also be claimed that they are 'soothing' and 'healing' ingredients. However, the proof for these claims is circumstantial. The dose-response effect of 4 alleged AI (nifedipine, (-)-alpha-bisabolol, canola oil and glycerol) was studied on experimentally induced acute irritation in healthy volunteers, and only glycerol showed dose-related response and effects potentially better than no treatment. The acute irritation model only allowed a small window of opportunity in which to demonstrate efficacy. Therefore, the effect of AI was studied in a cumulative irritation model by inducing irritant dermatitis with 10 min daily exposures for 5+4 days (no irritation on weekend) to 1% sodium lauryl sulfate on the right and 20% nonanoic acid on the left volar forearm. AI ointments were applied twice daily. Clinical scoring was performed daily, evaporimetry (Trans Epidermal Water Loss), hydration and colourimetry were measured at baseline (D0), in the middle and at the end of treatment. The glycerol ointment was the only treatment statistically better than both 'no treatment' and vehicle.

Short Contact Therapy with Tazarotene in Psoriasis Vulgaris

BACKGROUND

We present the results of a multicentre, not controlled, clinical study on the tolerability and efficacy of tazarotene gel, used as short contact therapy (SCT), in psoriasis vulgaris.

OBJECTIVE

To evaluate whether irritant contact dermatitis caused by tazarotene was less frequent and/or less severe with SCT than with traditional therapy, and whether SCT with tazarotene was as effective as traditional therapy.

METHODS

Forty-three patients with plaque psoriasis were treated by SCT with 0.1% tazarotene gel (once daily application for 20 min, followed by washing with water). Treatment duration was 45 days.

RESULTS

Irritant contact dermatitis caused by tazarotene used as SCT was much less frequent and severe than traditional treatment with the same drug. SCT with tazarotene was effective in the treatment of plaque psoriasis.

CONCLUSION

Tazarotene, used as SCT, was better tolerated than the same drug used as traditional treatment. Furthermore, SCT appeared to be as effective as traditional therapy with the same drug.

Irritant contact dermatitis induced by a common household irritant: A noninvasive evaluation of ethnic variability in skin response

OBJECTIVE

This study was undertaken to investigate the ethnic susceptibility to irritant contact dermatitis induced by a common dishwashing liquid using noninvasive technologies.

METHODS

A total of 30 participants (15 Caucasian, 15 African American) were patch tested to graded concentrations of a common household irritant and evaluated using clinical scoring, reflectance confocal microscopy, transepidermal water loss, and fluorescence excitation spectroscopy.

RESULTS

At 24 hours, the concentration thresholds for clinically perceptible irritancy were significantly higher for African American compared with Caucasian participants. Reflectance confocal microscopy showed stratum corneum disruption, parakeratosis, and spongiosis; these features were more severe in Caucasian participants (P < or = .002). Mean values for transepidermal water loss were significantly higher in the Caucasian group at comparable clinical scores (P < or = .005). Fluorescence excitation spectroscopy showed a broad excitation band at 300 nm (emission 340 nm) and values in both groups returned to baseline by day 7.

LIMITATIONS

This pilot study was limited in scope and larger studies are needed to further evaluate ethnic differences in irritant contact dermatitis and to demonstrate the applicability of our findings for other irritants.

CONCLUSION

Clinical evaluation, reflectance confocal microscopy, and transepidermal water loss showed significant differences in the cutaneous irritant response between both groups suggesting a superior barrier function of African American skin. Fluorescence excitation spectroscopy on the other hand demonstrated no differences in the hyperproliferative response after irritant exposure and indicated similar kinetics for the two groups.

Topical application of a novel immunomodulatory peptide, RDP58, reduces skin inflammation in the phorbol ester-induced dermatitis model

RDP58 is the first lead compound in a series of immunomodulating decapeptides discovered through activity-based screening and computer-aided, rational design. RDP58 disrupts cellular responses signaled through the Toll-like and tumor necrosis factor (TNF) receptor families and occludes important signal transduction pathways involved in inflammation, inhibiting the production of tumor necrosis factor alpha (TNFalpha), interferon-gamma, interleukin (IL)-2, IL-6, and IL-12. These pro-inflammatory cytokines are thought to be involved in the pathogenesis of several inflammatory and autoimmune diseases, including atopic dermatitis and psoriasis. The goal of this study was to determine the ability of RDP58 to inhibit skin inflammation following exposure to the well-characterized protein kinase C activator and tumor promoter 12-O-tetradecanoylphorbol-13-acetate (TPA). Topical application of RDP58 to the epidermis following TPA treatment resulted in the amelioration of the phorbol ester-induced irritant contact dermatitis. Substantial reductions were observed in skin thickness and tissue weight, neutrophil-mediated myeloperoxidase activity, inflammatory cytokine production, and various histopathological indicators. We also found RDP58 to be effective in reducing the compounding inflammatory damage brought on by chronic TPA exposure, and that it is capable of targeting inflammatory mediators specifically in the keratinocyte. These results demonstrate that topically applied RDP58 is an effective anti-inflammatory treatment in the phorbol ester-induced dermatitis model, and suggest that it may have therapeutic potential in a variety of immune-related cutaneous diseases.

Mechanisms of SEPA 0009-induced tumorigenesis in v-rasHa transgenic Tg.AC mice

Genetically engineered mouse models with altered oncogene or tumor suppressor gene activity have been utilized recently for carcinogen identification. The v-rasHa transgenic Tg.AC mouse, with its enhanced susceptibility to skin tumorigenesis, is thought to be well suited for examining the carcinogenicity of topically applied agents. Tg.AC mice were used to examine the carcinogenicity of SEPA 0009, a rationally designed organic molecule designed to enhance drug penetration through the skin. Fifty mg SEPA 0009/kg body weight, 1500 mg SEPA 0009/kg body weight, or the vehicle alone was applied daily to the skin of Tg.AC mice. Nontransgenic FVB/N mice were also treated with the vehicle alone or 1500 mg SEPA 0009. Daily application of a high-dose of SEPA 0009 caused severe and chronic irritation by 1 week that was maintained throughout the experiment. The irritation was accompanied by increased proliferation, increased apoptosis, and expression of the wound-associated keratin 6. High-dose SEPA 0009 induced squamous papillomas in Tg.AC, but not in nontransgenic mice, by 6 weeks. In mice treated with the high dose SEPA 0009, transgene expression was detected in papillomas at week 9, well after the onset of skin irritation and hyperplasia. In contrast, low-dose SEPA 0009 was not irritating to the skin and did not induce papillomas. Thus, SEPA 0009-induced tumorigenesis was associated with chronic and severe irritation. We propose that SEPA 0009-induced tumorigenesis in Tg.AC mice proceeds through an indirect mechanism that is secondary to cutaneous irritation.

Induction of a Hardening Phenomenon by Repeated Application of SLS: Analysis of Lipid Changes in the Stratum Corneum

Adaptation of the skin to repeated influence of exogenous irritants is called the hardening phenomenon. We investigated the stratum corneum lipid composition before and after induction of a hardening phenomenon. Irritant contact dermatitis was induced in 23 non-atopic volunteers by repeated occlusive application of 0.5% sodium lauryl sulfate (SLS) over 3 weeks. At 3, 6 and 9 weeks after irritation, the SLS responses of pre-irritated skin and normal skin were compared. The horny layer lipid composition (ceramides 1-7, cholesterol and free fatty acids) was assessed before irritation and 3, 6 and 9 weeks after irritation. During the first 2 weeks of irritation the transepidermal water loss increased continuously and seemed to decrease during the third week (effect of adaptation). The barrier function of pre-irritated sites was more stable to SLS challenge. Three weeks after irritation, there was a significant increase of ceramide 1 (p<0.001). The only volunteer without hardening phenomenon showed no increase of ceramide 1. Ceramide 1 seems to play a key role as a protection mechanism against repeated irritation.

Short-term effects of alcohol-based disinfectant and detergent on skin irritation

The most important risk factor for occupational contact dermatitis in hospital personnel is the exposure to irritants such as water, detergents and alcohol-based solutions. This study was undertaken to evaluate the short-term effects of repeated exposure to an alcohol-based disinfectant, to a detergent and to an alcohol-based disinfectant/detergent alternately. The hardening effect in preirritated skin after a 4-week interval was also evaluated. Detergent, disinfectant and disinfectant/detergent alternately were applied daily every 15 min for 6 h for 2 days to the flexor upper arms and forearms of 15 volunteers. A control area was included. After 4 weeks, a sodium lauryl sulfate patch was applied to each area. Irritant reactions were quantified by visual score, transepidermal water loss (TEWL) and skin colour at baseline, D3, D8, D35 and D37. As evaluated by clinical assessment, detergent caused more redness of the skin than both disinfectant applied alone and disinfectant/detergent alternately at D3 and D8, P < 0.001 and P < 0.001, respectively. An increased irritant response for detergent as compared to disinfectant alone and disinfectant/detergent was confirmed by TEWL and colour evaluations, P = 0.001 and P = 0.001 and P = 0.006 and P = 0.009, respectively. No hardening effect in preirritated skin was found after a 4-week interval. In conclusion, hand disinfection with alcohol-based disinfectant or alternate use of disinfectant/detergent causes less skin irritation than hand disinfection with a detergent. This study evaluated the short-term effects of disinfectant and detergent exposure only, and more long-term studies are necessary before recommendations can be made.

Are we reaching the limits or our ability to detect skin effects with our current testing and measuring methods for consumer products?

Testing for potential adverse skin effects is a key part of both the overall safety assessment for many consumer products and the evaluation of potential product improvements in mildness. Whilst modern tissue and paper products (i.e. facial tissues, catamenial products, baby wipes and baby and adult diapers) are inherently very mild to skin, current test methodology may not be robust enough to evaluate future improvements in such products. This article provides a commentary on several technologies we have been exploring to improve the sensitivity of test methods for tissue and paper products. The focus has been on three approaches: (i) further exaggerating exposure conditions using novel approaches to sample application, (ii) increasing the sensitivity of the manner in which we score for irritant effects, either visually or via instrumentation and (iii) quantitatively measuring additional endpoints, i.e. subjective sensory effects.

A clinicopathological study on acute cutaneous lesions induced by sulfur mustard gas (yperite)

During the Iran-Iraq war (1980-1988), sulfur mustard (as a chemical warfare agent) was launched on several occasions. Thirty-two victims with acute mustard poisoning were referred to our dermatology department, and are basis of this clinicopathologic study. Clinical and laboratory findings of these 32 adult patients exposed to mustard gas were determined. Skin biopsies were obtained from all of the patients and studied after staining of the specimens with routine and special stains. Clinically the most frequently involved areas were genitalia, face and axilla. The most common cutaneous findings were erosions, erythema and hyperpigmentation. The histopathologic changes of skin induced by mustard gas, included four distinct patterns: 1. Interface dermatitis, vacuolar type and lichenoid type; 2. Spongiotic dermatitis and bullous dermatitis (with or without acantholysis); 3. Pigmentary disorder pattern, increase of epidermal melanization. 4. Alteration of dermis/hypodermis, sclerodermoid pattern, vasculopathy and appendageal inflammatory response. Despite some specific characteristics related to sulfur mustard effect, these findings were compatible with histopathological changes of the chemical burns.

The effect of occlusive and unocclusive exposure to xylene and benzene on skin irritation and molecular responses in hairless rats

Aromatic hydrocarbons readily penetrate the skin on dermal exposure, leading to irritation, inflammation and cytotoxicity. The effects of short-term occlusive and long-term unocclusive dermal exposure to benzene and xylene on the skin irritation response (transepidermal water loss (TEWL), skin moisture content and erythema) and cytokine/chemokine expression (interleukin-1alpha (IL-1alpha), tumor necrosis factor-alpha (TNF-alpha) and monocyte chemoattractant protein-1 (MCP-1)) were investigated in hairless rats. Occlusive dermal exposure was carried out with 230 microL of the chemicals for 1 h using Hill top chambers. In unocclusive dermal exposure, 15 microL of the chemicals were applied to the skin every 2 h, for 8 h a day, for 4 days. The occlusive dermal exposure revealed a clear difference in the TEWL and erythema response of these chemicals (xylene>benzene) whereas unocclusive exposure revealed similar TEWL and erythema scores for both benzene and xylene. The expression of IL-1alpha was elevated 2.5- and 3.8-fold in response to occlusive and unocclusive exposure, respectively, vs control (P<0.01) for both the chemicals (benzene and xylene). Similarly, TNF-alpha levels were elevated about 2.4- and 6.0-fold as a result of occlusive and unocclusive exposure, respectively, vs control (P<0.01). These results show that unocclusive exposure induced significantly higher TNF-alpha expression than occlusive exposure (P<0.05). The MCP-1 expression in blood was slightly elevated compared with the control group, but this increase was not statistically significant (P>0.05). Similarly, MCP levels in skin were increased approximately 1.7- and 1.8-fold by occlusive and unocclusive exposure, respectively, compared with the control group (P<0.05). Our study demonstrates that the skin irritation profiles of benzene and xylene are similar and unocclusive long-term exposure to small amounts of these chemicals can induce more skin irritation and cytokine response than occlusive exposure.

Silicon Image Sensor Technology for in vivo Detection of Surfactant-Induced Corneocyte Swelling and Drying

BACKGROUND

Several instrumental methods can indirectly assess some specific aspects of cutaneous irritation at the level of the stratum corneum (SC).

OBJECTIVE

There is a need for developing more sensitive approaches in this field.

METHODS

We assessed a recently introduced innovative tool (SkinChip) based on capacitive pixel-sensing technology in its potential to detect early discrete manifestations of skin irritation. The sensor generates a detailed non-optical picture corresponding to a capacitance map of the skin surface reaching 50 microm pixel resolution. Some topographical details can be easily disclosed and the SC hydration as well. Two surfactant solutions were tested on volunteers. These solutions were applied under test patches for 2 days on the volar forearms. Clinical and SkinChip assessments were performed 3 h after removing the patch.

RESULTS

The generated images allowed a precise observation of skin irritation which appeared as a two-step process. Early changes consisted of darker pixels corresponding to overhydrated swollen corneocytes at the irritated sites. Two days later, the same area appeared as white pixels, indicating the loss of corneocyte hydration.

CONCLUSION

The SkinChip device appears to be a very sensitive tool for detecting the early steps of surfactant-induced skin irritation affecting the SC.

Sequential application of cold and sodium lauryl sulphate decreases irritation and barrier disruption in vivo in humans

BACKGROUND

Irritant contact dermatitis (ICD) is one of the most frequent types of occupational dermatitis. Different factors are involved in the development of contact dermatitis. In the food-processing industry, the combined exposure to different irritants may be involved in the development of ICD. Few data have been published regarding the irritant potential of sodium lauryl sulphate (SLS) in combination with cold.

OBJECTIVES

The present study was intended to analyse whether cold exposure and low skin temperature influence the development of ICD.

METHODS

Twenty (part I) and 12 (part II) healthy volunteers were exposed twice daily for 4 days to SLS alone, different low temperatures alone (4 degrees C six times for 90 s with an interval of 20 s or 15 degrees C for 10 min) or a combination of cold and SLS (19.6 microL SLS 1% cm(-2), part I; or 52.6 microL SLS 0.5% cm(-2), part II) using the tandem repetitive irritation test. Irritant cutaneous reactions were measured by noninvasive biophysical methods with transepidermal water loss as a parameter for permeability barrier function and skin colour reflectance together with visual scoring as parameters for inflammatory reactions.

RESULTS

Cold alone caused no significant skin reaction compared with untreated control. Exposure to SLS alone and SLS together with cold (independent of the applied temperature of 4 or 15 degrees C) twice daily induced a clear irritant reaction and barrier disturbance. Reactions did not differ whether SLS was applied before or after cold. Furthermore, 'tandem application' of cold and SLS diminished the barrier disruption and irritant reaction compared with SLS alone.

CONCLUSIONS

We conclude that the application of cold may have a protective effect on the development of ICD, at least in our short-term model.

Non-invasive evaluation of the kinetics of allergic and irritant contact dermatitis

Reflectance confocal microscopy (RCM) allows non-invasive visualization of human skin in vivo. It has been used to describe the histopathological features of acute contact dermatitis (CD). This work was designed to investigate the kinetics of both allergic and irritant CD (ACD and ICD) in vivo. Eighteen subjects with a prior diagnosis of ACD were patch tested with the specific allergen sodium lauryl sulfate as an irritant, and appropriate controls. RCM, transepidermal water loss (TEWL), and fluorescence excitation spectroscopy (FES) were performed at several time points within 2 wk after patch removal. After removal of the Finn chambers at 48 h, superficial epidermal changes, primarily involving the stratum corneum, and increased epidermal thickness were mainly present in ICD. ACD, on the other hand, showed microvesicle formation peaking at 96 h following patch removal. Both ACD and ICD showed exocytosis and similar degrees of spongiosis on RCM. TEWL and FES demonstrated a significant difference between ACD and ICD. RCM, TEWL, and FES are valuable non-invasive tools to quantitatively study the kinetics of the pathophysiology of acute CD reactions in vivo and monitor the changes at a cellular level.

Skin irritation: prevalence, variability, and regulatory classification of existing in vivo data from industrial chemicals

In vivo rabbit data for skin irritation registered in the European New Chemicals Database (NCD) and an ECETOC Database were evaluated to characterise the distribution of irritation potential among chemicals and to assess the variability of the animal test. These databases could be used to determine experimental and rudimentarily within-laboratory variability, but not between-laboratory variability. Our evaluation suggests that experimental variability is small. Using two classification systems--the system currently used in Europe and the Globally Harmonised System (GHS)--the prevalence of skin irritation data obtained from NCD was analysed. This analysis revealed that out of 3121 chemicals tested, less than 10% showed an irritation potential in rabbits which would require an appropriate hazard label and 64% did not cause any irritation. Furthermore, it appears that in practical use the European classification system introduces bias towards overclassification. Based on these findings, we conclude, that the classification systems should be refined taking prevalence into account. Additionally, prevalence should be incorporated into the design and analysis of validation studies for in vitro test methods and in the definition of testing strategies.