Barrier Creams Research Articles

Vernix Caseosa in Neonatal Adaptation

To characterize vernix caseosa in newborn infants with respect to factors that influence vernix distribution on the skin surface, vernix effects on thermal stability, skin hydration, acid mantle development, and vernix antioxidant properties. Vernix distribution was determined for 430 infants. Thermal stability was assessed in parallel groups following vernix retention (n=66) and removal (n=64). The effects of vernix retention on skin hydration, pH, erythema, and dryness/scaling were determined. Samples were analyzed for vitamin E before and after UV exposure. Vernix distribution depended upon gestational age, delivery mode, gender, race, and meconium exposure. Retention had no effect on axillary temperatures. Skin hydration was significantly higher for vernix-retained skin. Skin pH and erythema were significantly lower with retention. Vitamin E levels were decreased by ultraviolet radiation. Vernix is a naturally occurring barrier cream with multiple salubrious effects, which support its retention on the skin surface at birth.

Clocortolone pivalate cream in combination with a barrier cream in the control of irritant contact hand dermatitis

Clocortolone pivalate cream in combination with a barrier cream in the control of irritant contact hand dermatitis

Eyelid dermatitis with positive patch test to coconut diethanolamide

Objective: The aim was to detect a possible allergen in a patient with eyelid dermatitis. Patient and methods: a non atopic 27-year-old female presented with eyelid dermatitis since 3 months. This dermatitis persisted despite the fact she had stopped the use of make up; she had acrylic artificial nails since 2 months and sometimes used hair dyes;patch tests were performed with Finn Chamber® tests with readings at D2 and D3, according ICDRG criteria, with European standard series, additional series (including toluenesulfonamide formaldehyde resin), cosmetic, acrylates, hairdressing series, in 3 patch test sessions, using Chemotechnique Diagnostics® allergens. Results: The only positive patch test was coconut diethanolamide (0.5% pet.)++ at D2 and D3. After removal of the shampoo containing this allergen, the dermatitis cleared. Coconut diethanolamide (cocamide DEA), tensioactive synthesized with coconut oil is widely used in shampoos, soaps, shower gels, barrier creams, washing up liquids, metalworking fluids, hydraulic oils. Involvement of eyelids is not frequently described in the literature with this allergen. Conclusion: Coconut diethanolamide should be added in cosmetic series, and it should be useful to test this allergen in patients with eyelid dermatitis.

Transcutaneous penetration of toluene in rat skin a microdialysis study

Percutaneous absorption of lipophilic substances has major implications for therapeutical use or toxicological effects. We, therefore, using dermal microdialysis, measured local toluene concentrations and assessed the effects of duration of exposure, skin barrier disruption and the use of skin-care products. Three microdialysis membranes (3000 kDa) were inserted intradermally at a length of 2 cm in the abdominal skin of 82 anaesthetized male Wistar rats. They were perfused with albumin solution (5%) at 10 microl/min. A skin area of 1.5 x 0.6 cm above the membranes was exposed to toluene (100%, 200 microl) for 15 or 240 min. Dialysate was sampled at 20-min intervals. Using GC-FPD (gas charomotography flame photometric detector), it was analysed for toluene. In addition, the effects of tape stripping and pretreatment with topical products were assessed. In each of the 12 permutations of exposure time, pretreatments and tape stripping, five to eight animals were investigated. Maximum toluene concentrations were reached at 60 min after exposure (3.07 +/- 0.40 microg/ml, 15 min; 5.38 +/- 0.92 microg/ml, 240 min). In 15-min exposure experiments, dermal toluene concentrations decreased slowly to reach baseline values after 240 min. After 240-min exposure, a plateau of approximately 6 microg/ml was reached after 60 min. Neither tape stripping nor the pretreatment with barrier cream induced a significant change on dermal toluene concentrations. The slow kinetics of toluene penetration results in a steep concentration gradient in the skin with very-high local toluene concentrations and a delayed wash out, which might be relevant not only toxicologically, but also therapeutically.

Diaper Dermatitis

Eruptions in the diaper area are the most common dermatologic problem in infancy. Such eruptions can be subdivided into primary diaper dermatitis, an acute inflammation of the skin in the diaper area with an ill-defined and multifactorial etiology, and secondary diaper dermatitis, a term which encompasses eruptions in the diaper area with defined etiologies. The most important factors in the development of primary diaper dermatitis are: (i) water/moisture, (ii) friction, (iii) urine, (iv) feces, and (v) microorganisms (sometimes). Possible treatments include minimizing diaper use and using disposable diapers, barrier creams, mild topical cortisones, and antifungal agents. A variety of other inflammatory and infectious processes can occur in the diaper area and an awareness of these secondary types of diaper dermatitis aids in the accurate diagnosis and treatment of patients.

Hautschutzseminare zur sekundären Individualprävention bei Beschäftigten in Gesundheitsberufen: erste Ergebnisse nach über 2jähriger Durchführung

Zusammenfassung Hintergrund: Die Beschäftigten der Gesundheitsberufe haben ein erhöhtes Risiko, eine Berufshautkrankheit zu entwickeln. Seit Januar 2002 werden in der Abteilung Klinische Sozialmedizin, Berufs‐ und Umweltdermatologie des Universitätsklinikums Heidelberg in Zusammenarbeit mit der Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (BGW) Seminare zur sekundären Prävention von berufsbedingten Hauterkrankungen bei Angehörigen von Gesundheitsberufen durchgeführt. Zielkriterien sind Veränderungen des individuellen Schutz‐ und Pflegeverhaltens, Empfehlungen bezüglich der weiteren Diagnostik und Therapie, langfristige Besserung und Stabilisierung des Hautzustandes und Vermeidung einer Berufskrankheit nach BK 5101. Patienten und Methodik: Bei den zweitägigen Seminaren nehmen bis zu 14 Hauterkrankte teil. Darin werden sie über Aufbau und Funktion der Haut sowie notwendige Schutzmaßnahmen informiert. In praktischen Seminarphasen üben die Teilnehmer, Hautschutzmaßnahmen in ihre täglichen Arbeitsläufe zu integrieren. Ferner erfolgt eine ausführliche ärztliche Anamnese und Untersuchung. Diese ermöglicht dem Arzt, ein auf die individuellen Bedürfnisse angepasstes Hautschutz‐ und Hautpflegeprogramm auszuarbeiten und den Teilnehmern, alle anfallenden Fragen zu stellen. Ergebnisse: Von bisher 355 Teilnehmern (Stand: Mai 2004) waren 87,3 % Frauen mit dem durchschnittlichen Alter von 36,9 Jahren. 95 % der Betroffenen hatten ein Handekzem, das morphologisch häufig als dyshidrotischer Typ dominierte. Ätiologisch bestand in vielen Fällen ein Mischbild aus irritativem, atopischem und kontaktallergischem Handekzem, wobei insgesamt die irritativen Kontaktekzeme (43 %) dominierten. 68 % der Teilnehmer hatten eine atopische Hautdiathese. Das Seminar wird von den Teilnehmern durchgehend als gut eingestuft. Positiv sind sogenannte Seiteneffekte wie z. B. die Weitergabe des Erlernten an Arbeitskollegen, Familienmitglieder und Freunde. Schlußfolgerungen: Berufsdermatologische Untersuchungen und Beratungen werden bisher nur lückenhaft durchgeführt sowie Hautschutz‐ und Hautpflegemaßnahmen noch nicht ausreichend umgesetzt und angewandt. Es ist anzustreben, Hautschutzseminare zukünftig auch für andere hautgefährdende Berufszweige anzubieten.

The nursing care of common raw and bleeding skin conditions.

The skin is the largest organ in the body, is vital to the maintenance and balance of the body and is an indispensable structure for human life. The maintenance of healthy skin depends on factors such as moisture, the nutritional status of the patient and mechanical forces. Clever use of barrier films, barrier creams, emollients, steroid cream and observation of the patient's tissues over time, will protect the skin from external stimulants.

The benefits of implementing a new skin care protocol in nursing homes

This study explored the extent to which a new skin care protocol comprising a skin cleanser, barrier cream and barrier film could be implemented in nursing homes, and its effects on patients' skin condition, staff time and associated costs. A pre- and post-intervention study design was used. Data were collected on current skin condition and skin care procedures, before and after the introduction of a new skin care protocol. Nurses and carers were observed as they undertook skin care following episodes of incontinence. The time taken, products and amounts used were recorded. The presence and severity of incontinence dermatitis was recorded, together with the presence and severity of pressure ulceration. A supportive education programme was delivered to staff. All patients with incontinence and all staff working in six nursing homes were included in this study. Two nursing homes were randomly selected to participate in detailed skin assessments, documentation of skin care procedures and product usage. A total of 164 patients were included in detailed assessments, 79 pre-intervention, 85 post-intervention; 49 were male (29.9%) and 115 were female (70.1%). Their mean age was 83.44 years (standard deviation = 8.38). Only 3% of patients were under 70 years of age, with 72% over 80 years of age. Pre-intervention 29.1% were incontinent of urine only, 64.6% were doubly incontinent and 6.3% were catheterised. Post-intervention 29.4% had urinary incontinence, 65.9% were doubly incontinent, and 4.7% were catheterised. Skin condition was maintained or improved using the new skin care protocol. The presence of grade 1 pressure ulcers was found to significantly decrease over time (p = 0.042). The presence of incontinence dermatitis was found to be significantly lower after introducing the skin care protocol (p = 0.021). There was significant reduction in time taken to deliver skin care post-intervention (p < 0.001) with a mean time saving of 4 minutes and 2 seconds, per patient per procedure. On average this procedure was carried out 8.5 times per day, giving a time saving of 34 minutes and 17 seconds per patient per day using the new skin care protocol. This was associated with an average saving per patient per day of 8.83 Pounds for qualified staff and 3.43 Pounds for unqualified staff. Staff adherence to the new skin care protocol was good, with only one observed episode when the protocol was not followed, suggesting a high degree of success in its implementation. This study demonstrated that the introduction of a new skin care protocol, supported by an educational programme, maintained or improved patients' skin condition, and significantly reduced the resources used in delivering nursing care.

P16 Eyelid dermatitis with positive patch test to coconut diethanolamide

Objective: The aim was to detect a possible allergen in a patient with eyelid dermatitis. Patient and methods: a non atopic 27‐year‐old female presented with eyelid dermatitis since 3 months. This dermatitis persisted despite the fact she had stopped the use of make up; she had acrylic artificial nails since 2 months and sometimes used hair dyes;patch tests were performed with Finn Chamber® tests with readings at D2 and D3, according ICDRG criteria, with European standard series, additional series (including toluenesulfonamide formaldehyde resin), cosmetic, acrylates, hairdressing series, in 3 patch test sessions, using Chemotechnique Diagnostics® allergens.Results: The only positive patch test was coconut diethanolamide (0.5% pet.)++ at D2 and D3. After removal of the shampoo containing this allergen, the dermatitis cleared. Coconut diethanolamide (cocamide DEA), tensioactive synthesized with coconut oil is widely used in shampoos, soaps, shower gels, barrier creams, washing up liquids, metalworking fluids, hydraulic oils. Involvement of eyelids is not frequently described in the literature with this allergen.Conclusion: Coconut diethanolamide should be added in cosmetic series, and it should be useful to test this allergen in patients with eyelid dermatitis.

Möglichkeiten und Grenzen der Primärprävention von Handekzemen im Nahrungsmittelgewerbe

Individual protection measures, i.e. the use of barrier creams and protective gloves as well as skin care, are recommended for employees in skin risk occupations like in food industry. We investigated the short- and long-term acceptance, maintenance and efficacy of different prevention strategies (skin protection and care measures (SP), prevocational UV hardening (UV)) in bakery trainees. Demographic profile and atopy criteria were equally distributed in the 2 intervention arms and the control group (C). Skin protection measures were accepted and taken up to a varying amount during the course of training in the groups. Barrier cream and skin care use in the SP group reached 100% and 90%, respectively, at the end of the observation period. The level of acceptance of glove use (43.3%) was considerably lower. Point prevalence of HD in the groups after 6 months was highest in the C (29.1%) followed by the UVB (19.4%) and the SP group (13.3%). UVB hardening and SP measures were associated with a reduction in HD prevalence by 9.7% (95% CI -8.5 - 28.1) and 15.8% (95% CI -2.4 - 33.9), respectively. Application of SP measures reduced the OR for HD 0.8 (95% CI 0.17 - 3.70) and 0.33 (95 % CI 0.09 - 1.23) fold compared to the UVB and C group, respectively. These clinical trends were underpinned by statistically significant differences in basal TEWL levels. Adequate and regular skin protection and care seem to be promising in the prevention of occupational hand dermatitis. The experimental concept of preoccupational UV induced skin hardening did not meet the expectations and cannot be recommended so far.

Diaper dermatitis--an overview.

Diaper dermatitis, also know as nappy rash, is an inflammation of the skin covered by nappy. It probably results due to an interaction of multiple factors like increased wetness, elevated pH due to urine, fecal enzymes and microorganisms under the nappy. It manifests as an erythematous rash occurring on the convex surfaces of skin under the nappy. Rashes resembling nappy dermatitis can also be caused by some diseases which may have serious systemic manifestations. Therefore it is essential to differentiate and treat them. The principle of treatment of diaper dermatitis is to keep the skin in the nappy area as dry as possible with frequent nappy change. The superabsorbent disposable diapers are known to reduce the incidence of diaper dermatitis. Barrier creams to protect the infant's skin and mild topical corticosteroids to reduce the inflammation are mainstays of therapy. The incidence and severity can be reduced by keeping the skin dry under the nappy and protected from irritants and infections.

Wirksamkeit von Hautschutzprodukten im Vergleich zu Hautpflegeprodukten bei Zahntechnikern – eine kontrollierte Feldstudie

Zusammenfassung Hintergrund: Die irritative Kontaktdermatitis der Hände ist bei Zahntechnikern infolge der zahlreichen Kontakte mit verschiedenen Irritantien sehr häufig. Hautschutzprodukte (HS) werden oft vermieden, weil ein fester Griff von Werkzeugen und kleinen Objekten notwendig ist; weiterhin dürfen die dentalen Objekte nicht durch Hautschutzprodukte kontaminiert werden. In dieser Studie sollte die Wirksamkeit von Hautschutzprodukten, die während der Arbeit eingesetzt wurden, mit Hautpflegeprodukten (HP) verglichen werden, die nach der Arbeit verwendet wurden. Methode: Zwei bekannte, kommerzielle HS (HS‐1, HS‐2) und zwei Hautpflegeprodukte mit Harnstoff bzw. Bienenwachs (HP‐1, HP‐2) wurden in fünf Zahntechniklaboren durch insgesamt 192 Zahntechniker evaluiert. Jeder Zahntechniker verwendete ein HS (mehrere Applikationen während der Arbeitsschicht) und ein HP, angewendet mindestens ein Mal täglich zu Hause für vier Wochen, jeweils mit einer „wash‐out‐Periode” von zwei Wochen dazwischen. Die Sequenz HS‐HP bzw. HP‐HS wurde für jedes Labor randomisiert in zwei einfache, blinde Cross‐over‐Designs für beide Kombinationen (HS‐1 + HP‐1, HS‐2 + HP‐2). Die Zahntechniker bewerteten die Produkte auf einer Wirksamkeitsskala (schlechter, keine, gut, sehr gut). Der Hautzustand wurde durch einen Dermatologen zu Beginn der Studie, nach vier, sechs und zehn Wochen unter Bildung eines Summenscores auf einer Skala für Erythem, Infiltration, Bläschen, Fissuren und Schuppung evaluiert. Außerdem wurde der transepidermale Wasserverlust (TEWL) auf dem Handrücken und auf der Beugeseite des Unterarms zu Beginn und am Ende der 4‐wöchigen Produktanwendung gemessen. Der Quotient dieser zwei Parameter wurde für die statistische Auswertung herangezogen (Co‐Varianz‐Analyse). Ergebnisse: Die Bewertung von „gut” und „sehr gut” war für HS‐1 58 %, HS‐2 67 %, HP‐1 77 %, HP‐2 98 %. Beide HP wurden besser als die HS bewertet, insbesondere HP‐2. Dies wurde bestätigt durch die Verbesserung des Hautzustandes (HS‐1 35 %, HS‐2 44 %, HP‐1 55 %, HP‐2 56 %). Statistisch signifikante Unterschiede beim TEWL wurden gefunden für: HP‐1 besser als HS‐1 (p = 0,007); HP‐2 besser als HS‐2 (p = 0,03). Die Akzeptanz der Produkte war hoch. Die Mehrheit der Zahntechniker war bereit, die Behandlung so fortzuführen (68 – 89 %). Schlußfolgerungen: Die Ergebnisse zeigen, daß die Anwendung von Hautpflegeprodukten nach der Arbeit sehr wirksam ist und unter den gewählten Studienbedingungen den während der Arbeit eingesetzten Schutzprodukten überlegen war. Die intensive Anwendung von Hautpflegeprodukten nach der Arbeit wäre für viele Berufe praktikabel und könnte zu einer deutlichen Reduktion der Häufigkeit von irritativer Kontaktdermatitis führen.

Chemical Warfare Agents: Their Past and Continuing Threat and Evolving Therapies Part I of II

Chemical warfare agents are potentially accessible to even underdeveloped nations because they are easily and inexpensively produced. This means that they are ideal for use by terrorists and in military operations against civilian populations and troops. In terms of cutaneous injury, vesicants-mainly sulfur mustard-are the most significant chemical warfare agents. Advances in understanding the pathophysiology of the lesions produced by sulfur mustard have led to the research and development of barrier creams as well as pre- and post-exposure therapies to moderate the damage and accelerate healing. Part I of this paper will discuss the history and classification of chemical agents; Part II, which will appear in the September/October 2003 issue of SKINmed, will discuss characteristic manifestations of exposure to chemical agents, as well as prevention and therapy.

Problems with trials and intervention studies on barrier creams and emollients at the workplace.

The potential effect of barrier creams or emollients in the prevention of work-related hand eczema has mostly been documented in a laboratory setting on experimentally damaged skin. Publications on real intervention studies of barrier creams or emollients in a workplace setting are scarce: only four such studies could be identified. The relatively short follow-up of most studies, and the small numbers of subjects enrolled, may reflect the organisational complexity of such studies. The observed effect is a combination of the intervention effect to be measured, and a number of disturbing variables. These disturbing variables are not just measurement error, but also phenomena such as the course of the disease, confounding and effect modification. In hand-eczema studies, the outcome parameters that should form the basis of the intervention effect are ill defined. Moreover, the study itself (i.e. the investigators) influences the results because there is rarely a single intervention: unknowingly, there are improvements in glove wearing, hand-washing habits or occupational hygiene in general. The performance of a blind study is often difficult or impossible. Large numbers of subjects have to be enrolled if a meaningful reduction in incidence of hand eczema is to be detected. One can demonstrate this by calculating the required enrollment in a study among employees in a nursing home.

Effectiveness of skin protection creams as a preventive measure in occupational dermatitis: a critical update according to criteria of evidence-based medicine.

This study attempts to assess the evidence of the generally recommended three-step programme of skin protection in the prevention of occupational skin disease. The following clinical questions, representative of critical appraisal of this preventive measurement, were generated: (1) Can a skincare regimen effectively reduce or eliminate work-related poor skin conditions? (2) Do protective creams prevent harmful substances from penetrating and adhering to the skin? (3) Is the differentiation between pre-exposure and post-exposure products justified by reliable data? Answers were generated according to the method used in evidence-based medicine by searching the literature, critically appraising the results and applying the results to the clinical questions. For our search we decided to use PubMed as the most convenient access to Medline and because, in contrast to other databases, this access is available free of charge. To investigate the efficacy of barrier creams as pre-exposure skin protectors various in vitro and in vivo test methods have been developed. Over the past years the test techniques have been improved in order to adopt a real workplace situation. Efforts for standardisation of evaluation criteria have been made, too. Nevertheless, there is a lack of placebo-controlled, randomised clinical trials evaluating the benefit of these products in the prevention of occupational contact dermatitis under real workplace conditions. The literature data are conflicting; some publications report on the positive aspects of skin protection, whereas others stress the negative ones. Not enough data have been accumulated for one to prove the benefit of skin protection measures under real workplace condition. Up to now, it is almost unclear if the various in vitro and in vivo methods used are suitable to simulate real workplace conditions and if these test results can be related to real occupational exposure. For the evidence-based recommendation of skin protection, further studies, especially under daily working conditions evaluating the contribution of each single element of skincare programme (products, frequency of application and education programme) are needed.

Evaluation of Barrier Creams against Sulphur Mustard

The purpose of this study was to assess the effectiveness of a range of passive and reactive barrier cream formulations against the chemical warfare agent sulphur mustard (SM) using an in vitro diffusion cell system containing human skin. In general, proprietary formulations were relatively effective under occluded conditions, but ineffective under unoccluded conditions. For example, SM skin absorption rates through occluded control and Stokoderm^® pre-treated skin were 538 ± 193 and 200 ± 51 µg·cm^–2·h^–1, respectively (p < 0.05). Under unoccluded conditions, control and Stokoderm pre-treated skin absorption rates were 4.41 ± 1.90 and 36.84 ± 15.19 µg·cm^–2·h^–1 (p < 0.05). Novel (perfluorinated) barrier creams were generally more effective under unoccluded conditions; pre-treatment with one formulation led to an 18-fold reduction in skin absorption rate and reduced the total amount of SM penetrated by 95% of the applied dose. Several proprietary formulations also had adverse effects on the effectiveness of the skin decontaminant fuller’s earth. The rate (Jss) and total amount (percentage of dose) of SM absorbed through the skin were deemed to be independent parameters of barrier cream performance. These data indicate that (1) perceived conditions of use, (2) compatibility with existing protective equipment and (3) the rate and extent of SM skin absorption must all be taken into account when evaluating barrier creams in vitro.

Do continence aids help to maintain skin integrity?

The third of our back to basics series reviews the efficacy of continence aids such as pads and barrier creams, and their role in maintaining skin integrity. Many studies had flaws and new research is needed to avoid subjective choice of products.

Barrier creams--skin protectants: can you protect skin?

Barrier creams (BC) are used in hand care to protect the user against damage from surfactants and other irritants; their clinical value remains debatable; some reports indicate that inappropriate BC application might induce a deleterious rather than a beneficial effect. Since many cosmetic formulations contain 'skin protectants', we review concept, application, and efficacy from the pertinent scientific literature.

Dimethicone barrier cream prevents infection of human skin by schistosome cercariae: evidence from Franz cell studies.

One approach to the prevention of schistosomiasis is the use of topical formulations to inhibit cercarial penetration of skin. A number of formulations containing either cercaricidal ingredients or components designed to inhibit penetration have been studied, but with variable results. Such studies have rarely considered the persistence of inhibitory effects through time, and to date, there have been no systematic investigations of barrier formulations. The aim of this study was to use Franz cells to investigate the effect of such barrier creams on the penetration of S. mansoni cercariae into human skin. The results show that a single application of a barrier cream based on dimethicone offers a high level of protection against penetration that is sustained for at least 48 hr.

Dimethicone Barrier Cream Prevents Infection of Human Skin by Schistosome Cercariae: Evidence from Franz Cell Studies

Dimethicone Barrier Cream Prevents Infection of Human Skin by Schistosome Cercariae: Evidence from Franz Cell Studies