Acute irritant contact dermatitis: recovery time in man

Our understanding of the details of the recovery time of acute irritant contact dermatitis (ICD) is limited. We examined skin reactivity to a model surfactant, sodium lauryl sulfate (SLS). on previous acute ICD and normal sites over time with visual grading and noninvasive instruments. Acute ICD was induced on the upper arms of 18 volunteers (aged 30 to 51 years) by occluded application of 1% SLS for 24 h. Previous ICD and normal sites were provoked by occluded application of 2% or 7.5% SLS 30 min daily 4 consecutive days. Skin reactivity was assessed daily by visual erythema scoring (VES), transepidermal water loss (TEWL), skin color reflectance (SCR) and electrical capacitance (EC). Skin function of previous ICD sites assessed, by VES, TEWL. SCR, and EC did not normalize until 2 weeks later: all parameters of previous ICD returned to normal after 3 weeks. While skin reactivity to 2% und 7.5% SLS showed no differences between previous ICD and normal sites at 4 weeks, differences of irritant reactivity especially 7,5% SLS between previous ICD and normal sites were significant at 3 weeks post-provocation. Our results demonstrate that irritation evaluated with irritant provocation was long-lasting, even though skin functional parameters assessed by various bioengineering instruments returned to normal. Complete recovery of skin function including irritability after acute ICD induced by 1% SLS was achieved approximately 4 weeks later. The date were generated with a model surfactant: it remains to be determined whether similar responses will be noted with chemicals of different physicochemical properties.     

Sea water or its components alter experimental irritant dermatitis in man

Background/aims: Ocean bathing has been considered "healthy" for skin, but its efficacy remains testimonial in nature. Our aim was to evaluate the effects of sea water and its main components on experimental irritant contact dermatitis induced by sodium lauryl sulphate (SLS) cumulative irritation.
Methods: After open application of 2% SLS for 10 min on volar forearm sites, solutions of sea water, 500 mM NaCl, 10 mM KCl, 55 mM MgCl₂, 10 mM CaCl₂, or deionized water were separately applied using filter paper discs for 20 min. The procedures were repeated daily for 2 weeks. The effects of the treatment were assessed daily using measurements of transepidermal water loss (TEWL), as an indicator of epidermal barrier function, and capacitance, as a parameter of stratum corneum water content.
Results: Sea water, NaCl, and KCl significantly inhibited the increase of TEWL as compared with deionized water ( P <0.003, P <0.05, P <0.05, respectively). Sea water and NaCl inhibited the decrease of capacitance as well ( P <0.03, P <0.01).
Conclusion: The effect of sea water may be attributed to skin barrier preservation by NaCl and KCl, and an emollient effect by NaCl.     

Sodium lauryl sulfate (SLS) induced irritant contact dermatitis: a correlation study between ceramides and in vivo parameters of irritation

Sodium lauryl sulfate (SLS), a surfactant frequently used in the induction of experimental irritant contact dermatitis in animals and in humans, characterstically induces a dose-related increase in TEWL (transepidermal water loss). Ceramides are considered to be important in the regulation of the skin barrier. We therefore examined the relationship between initial ceramide content of stratum corneum and induced changes in skin color (erythema) and barrier function, after SLS application under occlusion (1% and 3% in water) to the forearm of 14 volunteers. Stratum corneum sheets were removed, stratum corneum lipids extracted, and ceramide composition determined from chromatograms (TLC) using densitometry. After determining baseline skin color and TEWL at each area. 2 samples of stratum corneum were obtained from each volunteer. Clinical and instrumental controls of the SLS-induced irritation were performed at 24, 48, 72 and 96 h. Erythema was evaluated by colorimetry; barrier impairment by changes in TEWL. We found inverse correlations between baseline ceramide 61 (weight) and the 24 h erythema score for SLS: between ceramide I and 24 h TEWL, and between ceramide 611 and 72 h TEWL for SLS 3%. Our findings suggest that low levels of these ceramides may determine a proclivity to SLS-induced irritant contact dermatitis.     

Chronic irritant contact dermatitis: recovery time in man

Chronic irritant contact dermatitis (ICD) is a common skin disease, especially in the workplace, but determining the recovery time of chronic ICD is not easy. To measure the recovery time of chronic ICD, we examined the skin reactivity to a model surfactant, sodium lauryl sulfate (SLS), on previous chronic ICD and normal sites by visual grade and non-invasive instruments. Chronic ICD was induced on the forearms of 10 volunteers (aged 23 to 43 years) by occluded application of 1% SLS for 30 min on 5 consecutive days each week for 3 weeks. Previous ICD and normal sites were provoked by the occluded application of 7.5% SLS for 30 min daily on 4 consecutive days, 2, 5 and 10 weeks after induction. Skin reactivity was assessed daily by awarding visual erythema scores, visual scale scores and measuring transepidermal water loss, skin color reflectance, and electrical capacitance. Skin reactivity of previous chronic ICD sites to SLS showed hyperreactivity compared to normal sites even after the 10th week post-induction.     

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

We evaluated the effect of subclinical irritation on the cutaneous reaction elicited by cumulative short-term (30-min) application of sodium lauryl sulphate (SLS), by measuring transepidermal water loss (TEWL) and assigning visual scores. 11 healthy adult volunteers, free of skin disease and with no history of atopic dermatitis, were treated with SLS solution (1%, 2%, 5%, 7.5%). On a Monday, we applied 80 μl of 1% SLS solution and deionized water (control), using large aluminum chambers with filter paper discs, for 30 min. We measured TEWL values 2x before and after patch application of control and 1% SLS solution, and then applied 80 μl of SLS solution (2%. 5%. 7.5%) using filter paper discs. From Tuesday to Friday, we applied 80 μl of each solution, using filter paper discs, and measured TEWL before and after open application of test solutions. Compared with each corresponding group, TEWL values of SLS patch groups (S-2.0, S-5.0, S-7.5) were higher than, those of water patch groups (W-2.0, W-5.0, W-7.5), respectively. TEWL values of each groups increased stepwise and the final (hour 97) TEWL values were higher than those of baseline (hour 0) TEWL. The mean visual scores of the vehicle control were lower than those of other test groups, but there were no statistically significant differences in visual scores between each test group. These findings suggested that impaired skin barrier function, elicited by subclinical irritation from short-duration contact with some irritants, might augment the cumulative irritant contact dermatitis caused by repeated open exposure to other surfactants. Relatively short-term and minimal exposure, not in great excess of many daily surfactant exposures, produced cumulative irritation. TEWL measurements were more discriminating than visual grading.     

Intra-individual variation of irritant threshold and relationship to transepidermal water loss measurement of skin irritation

Irritant susceptibility studies have used either visual assessment or transepidermal water loss (TEWL) to determine subject response. We have developed a visual assessment method which determines subject irritant threshold. We examined the relationship between sodium lauryl sulfate (SLS) irritant threshold and TEWL measurements from normal skin and SLS patch tests. 19 subjects were recruited. The irritant threshold of each subject was measured and TEWL measurements made from the applied SLS patch tests. Individuals with a lower irritant threshold (easily irritated skin) had elevated TEWL levels compared to those with higher thresholds. The irritant threshold test had a low intraindividual variation. This study showed that the 2 methods grouped patients in a similar manner. The variation seen may reflect the different outcomes measured: irritant threshold visually assesses the skin inflammatory response while TEWL measures skin barrier modification.     

Multiple parameter assessment of vulvar irritant contact dermatitis

Transepidermal water loss (TEWL), capacitance, pH, blood flow and color reflectance were evaluated for quantifying the irritant response of vulvar and forearm skin to 3% sodium lauryl sulfate in 9 healthy premenopausal women. TEWL, capacitance, pH, blood flow, and all parameters of color reflectance changed significantly in forearm irritant dermatitis. In vulvar irritant dermatitis, however, significant changes were observed only for blood flow and the color reflectance parameters a* and b*. Using the combination of TEWL, capacitance and blood flow, forearm irritant dermatitis was detected with a sensitivity of 84% and a specificity of 100%. In this study, the best combination of parameters to detect vulvar irritant dermatitis was pH, blood flow, a* and b*, which had a sensitivity of 78% and a specificity of 75%. It is concluded that available bioengineering techniques are less suitable to quantify irritant dermatitis in the vulva than in the forearm.     

Impact of glove occlusion on cumulative skin irritation with or without hand cleanser–comparison in an experimental repeated irritation model

Background. Irritant contact dermatitis remains a substantial problem in the food processing industries. Irritants that are weak by themselves, such as glove occlusion and mild detergents, could interact to produce contact dermatitis. Objectives. To model the irritant action of an antibacterial hand cleanser and glove occlusion, with sodium lauryl sulfate (SLS) as a positive control. The effects of a pre‐exposure cream and a post‐exposure cream were also investigated. Methods. A modified repeated short‐time occlusive irritation test with 20 healthy volunteers, and application of irritants over 4 days, with pre‐exposure and post‐exposure creams and overnight glove occlusion, was performed. The changes in transepidermal water loss (TEWL) served as a measure of the irritant damage to the epidermal barrier. Results. The antibacterial cleanser and the glove occlusion separately induced only minor increases in TEWL. When combined, the two showed a tandem effect, as the TEWL increase was significantly higher, and was similar to that seen with the positive control, SLS. The pre‐exposure and post‐exposure creams alone significantly mitigated the cumulative irritation, and this effect was strongest when the two creams were combined. Conclusions. Irritant contact dermatitis may develop through the tandem effects of long‐term glove occlusion and the accumulation of barrier damage from hand washing, even when mild hand cleansers are employed.     

Effect of an antioxidant (quercetin) on sodium-lauryl-sulfate-induced skin irritation

Quercetin is a bioflavonoid with antioxidant and anti-inflammatory activity. The purpose of this study was to examine the effect of quercetin on acute skin irritation, with special interest in the skin barrier function recovery. Acute irritant contact dermatitis was induced in 15 patients by 24-h occlusion of 2% sodium lauryl sulfate (SLS) (day (D) 1). The influence of application on SLS-irritated skin of topical quercetin for 5 consecutive Ds, compared to vehicle and controls, was studied. Parameters measured were transepidermal water loss (TEWL) and erythema index. Final measurements were taken on D 7 after a 1-D rest period. TEWL and the erythema index continued to rise 2 D after application of SLS and 1 D after treatment with quercetin, vehicle or controls. Both TEWL and erythema values at D 7 did not return to values before the SLS barrier disruption at all the test sites. Therefore, quercetin topically applied after induction of irritant contact dermatitis does not appear to increase the recovery of barrier function and erythema caused by SLS.     

Baseline transepidermal water loss in patients with acute and healed irritant contact dermatitis

To examine the skin harrier function of patients with acute and healed irritant contact dermatitis ( n = 80) baseline transepidermal water loss (TEWL) was quantitatively measured using an evaporimeter. Healthy subjects served as controls ( n = 40). Test areas were the forearm and the thigh. A significant increase in TCVV'L was observed in the patients with acute and with healed irritant contact dermatitis (ICD) as compared LO healthy volunteers ( P ≤ 0.01). TEWL values in both test areas were com parable and markedly correlated ( p ≤ 0.01). with each other in every group. Thus, it is possible that basal TEWL depends more on the intrinsic skin barrier function of the subjects rather than the 2 anatomical regions examined. TEWL at the forearm with acme ICD was significantly higher ( P ≤ 0.01). than that of the group with healed ICD, but not for TCWL at the thigh suggesting that ICD may aggravate the barrier function of the adjacent involved skin. It is assumed, that increased basal TEWL in patients with ICD may relied a constitutional deviation of epidermal barrier function. This event seems to be comparable with the well-known symptom of atopic individuals. Using a detailed atopic scoring system in such a study may clarify the question of whether a proportion of patients with hand ICD may indeed be atopic individuals.     

Urea-containing moisturizers influence barrier properties of normal skin

Moisturizers are used in the treatment of dry skin, both clinically and in cosmetic products. In the present study the influence of different moisturizers on the normal skin barrier properties was evaluated by measuring transepidermal water loss (TEWL) and skin capacitance. In addition, the skin reactivity to a topically applied surfactant, sodium lauryl sulphate (SLS), following the use of the moisturizers was examined. The skin reaction was assessed visually and by measuring TEWL and superficial blood flow. Treatment with two urea-containing moisturizers for 10 and 20 days decreased TEWL. The irritant reactions after exposure to SLS were also significantly decreased after prior treatment for 20 days with the urea-containing moisturizers. In a double-blind vehicle-controlled part of the study, urea was found to decrease the skin susceptibility to SLS after only three applications. However, this decrease in skin reactivity was not preceded by a reduction in TEWL. Skin capacitance increased after three applications of urea-containing moisturizers and was still increased after 10 days, but not after 20 days of this treatment. Treatment for 20 days with two moisturizers without urea did not influence either TEWL or the susceptibility to irritation from SLS, but it increased the skin capacitance significantly. The mechanism underlying these changes is not known. The lower degree of SLS-induced irritation in the skin treated previously with urea-containing moisturizers may be of clinical relevance in reducing contact dermatitis from irritant stimuli. Received: 5 January 1995     

Barrier recovery and influence of irritant stimuli in skin treated with a moisturizing cream

Moisturizers are used daily by many people to alleviate symptoms of clinically and subjectively dry skin. Recent studies suggest that certain ingredients in creams may accelerate the recovery of a disrupted barrier and decrease the skin susceptibility to irritant stimuli. In the present single-blind study, a moisturizing cream was tested for its influence both on barrier recovery in surfuctant-damaged skin and on the susceptibility of normal skin to exposure to the irritant sodium lauryl sulphate (SLS). Parameters measured were transepidermal water loss (TEWL) and skin corneometer values, indicating degree of hydration. Treatment of surfactant-damaged skin with the test cream for 14 days promoted barrier recovery, as observed as a decrease in TEWL. Skin corneometer values also normalized more rapidly during the treatment. In normal skin, use or the test cream significantly reduced TFWL after 14 days of treatment, and irritant reactions to SLS were, significantly decreased. Skin corneometer values increased after only 1 application and remained elevated after 14 days. In conclusion, the accelerated rate of recovery of surfactant-damaged skin and the lower degree of SLS-induced irritation in normal skin treated with the test cream may be of clinical relevance in attempts to reduce contact dermatitis due to irritant stimuli.     

Effects of glycerol on human skin damaged by acute sodium lauryl sulphate treatment

Glycerol, widely used as humectant, is known to protect against irritants and to accelerate recovery of irritated skin. However, most studies were done with topical formulations (i.e. emulsions) containing glycerol in relatively high amounts, preventing drawing conclusions from direct effects. In this study, acute chemical irritations were performed on the forearm with application of a 10% sodium lauryl sulphate (SLS) aqueous solution under occlusion for 3 h. Then, glycerol aqueous solutions from 1 to 10% were applied under occlusion for 3 h. After elimination of moist excess consecutive to occlusive condition, in ambient air for 15 and 30 min, skin barrier function was investigated by dual measurement of skin hydration and transepidermal water loss (TEWL). Treatments with SLS solution under occlusion significantly increased TEWL and decreased skin hydration as assessed by capacitance measurements. The SLS irritant property was raised by the occlusion and the water barrier function as well as water content appeared impaired. Recovery with glycerol at low doses was remarkable through a mechanism that implies its hygroscopic properties and which is saturable. This precocious effect acts through skin rehydration by enhancing water-holding capacity of stratum corneum that would facilitate the late physiological repair of impaired skin barrier. Thus, glycerol appears to substitute for natural moisturizing factors that have been washed out by the detergent action of SLS, enhancing skin hydration but without restoring skin barrier function as depicted by TEWL values that remained high. Thus, irritant contact dermatitis treated with glycerol application compensate for skin dehydration, favouring physiological process to restore water barrier function of the impaired skin. Empirical use of glycerol added topical formulations onto detergent altered skin was substantiated in the present physicochemical approach.     

Increased stratum corneum turnover induced by subclinical irritant dermatitis

The chronic effects of the irritant sodium lauryl sulphate (SLS) on stratum corneum (SC) barrier function, determined by transepidermal water loss (TEWL) measurements and on epidermal cell kinetics, estimated by stratum corneum turnover time (SCTT) determination (dansyl chloride staining method), were investigated in 18 healthy female volunteers. SLS (7.5%) was applied without occlusion for 20 min once daily, over a period of 3 weeks (5 days a week) on dansyl chloride-stained skin and on untreated skin. SCTT of untreated skin (19.3 +/- 0.8 days; mean +/- SEM) was not changed by daily treatment with water (control) (19.3 +/- 2.0) but was significantly reduced by SLS (10.9 +/- 0.6; P less than or equal to 0.0001; compared to controls). However, TEWL was increased in SLS-treated sites 1.5-fold after 4 days of treatment (5.3 +/- 0.6 vs. 3.5 +/- 0.3; P less than 0.001). At the end of the second week, TEWL was increased 2.6-fold and after 3 weeks TEWL was 3.3 times higher than in controls 13.0 +/- 1.6 vs. 3.9, P less than or equal to 0.0001). The intensity of SLS-induced irritation as measured by TEWL was significantly correlated with baseline TEWL (r = 0.50; P less than or equal to 0.02) and significantly negatively correlated with SCTT of SLS treated sites (r = -50; P less than or equal to 0.02) but not with SCTT of untreated skin (r = 0.19).     

Pathological findings in cumulative irritation induced by SLS and croton oil in hairless mice

It is known that the pathological features of acute irritant contact dermatitis are specific according to the irritant. However, in chronic irritant contact dermatitis, it is not clear whether specific patterns exist. To investigate whether the specific pathology of acute irritant contact dermatitis is sustained in chronic irritant contact dermatitis, sodium lauryl sulfate (SLS) and croton oil were applied 3x a week for 2 weeks on the dorsal skin of hairless mice using Finn Chambers. The pathologic changes induced by irritants at various concentrations were evaluated using H&E and Luna's staining, as well as immunohistochemistry for 5-bromo-2-deoxyuridine (BrdU), keratin 6 and loricrin. Our results showed that epidermal hyperplasia and inflammatory infiltration were relatively marked in the groups treated with higher concentrations of irritants. These features were more prominent in the 1% croton oil treated group than in the 0.25% SLS treated group. However, lower concentrations of irritants resulted in very similar histological changes, characterized by epidermal hyperplasia with minimal inflammatory infiltration, irrespective of the chemical. Our results suggest that the histological responses to irritants vary with concentration in cumulative irritation, as in acute irritation, but repetitive mild irritation may evoke common histological changes, characterized by epidermal hyperplasia with minimal inflammatory infiltration, irrespective of the chemical used.     

Beneficial effects of a skin tolerance-tested moisturizing cream on the barrier function in experimentally-elicited irritant and allergic contact dermatitis

In experimentally-induced irritant (ICD) and allergic (ACD) contact dermatitis, an oil-in-water (o/w) cream was applied to investigate its effects on a disturbed barrier function compared to untreated physiological barrier repair. Transepidermal water loss (TEWL) measurements were performed. Before the start of the experiments, the skin tolerance of the cream was examined, revealing the non-irritating characteristics of the ingredients and the absence of any contact allergic patch test reaction. In the ICD study, sodium lauryl sulfate (SLS) patches were applied to the forearms of young female volunteers. Consequently, it was observed that repeated cream application (14 days, 2x/day) significantly improved the TEWL of SLS-damaged skin, leading to a complete recovery on day 15. In the ACD study, disruption of skin barrier function was obtained by a nickel-mediated contact allergy patch (CAP) test. The cream was then applied 2x/day for 4 consecutive days. Assessment of TEWL clearly showed that recovery of the disrupted skin significantly improved after cream application in comparison to untreated barrier repair.     

On the course of the irritant reaction after irritation with sodium lauryl sulphate

Background: The sodium lauryl sulphate (SLS) irritation test is a well-established model for irritant contact dermatitis after the effects of surfactants.
Aim of the study: The course of changes in corneometric measurements (stratum corneum hydration), in transepidermal water loss (TEWL), in laser Doppler measurements (epidermal perfusion) and in colorimetric measurements (skin redness), after a single SLS irritation, should be studied over time.
Methods: Twenty healthy volunteers were studied. Irritation with 1% SLS solution was applied to the side of one forearm for 24 h under occlusive conditions, while the symmetrical experimental site remained untreated. Measurements were made for 9 days after completion of SLS irritation.
Results: Stratum corneum hydration was reduced immediately after irritation, and subsequently a hyper-hydration was observed. The increase in TEWL, laser Doppler measurements and skin redness persisted for 7–9 days. With regard to skin redness, a mild blanching effect was noticeable after 9 days.
Discussion: The evidence of very short-term exsiccation of the stratum corneum with persistent barrier damage, as well as reactive hyper-hydration and blanching of the skin, is remarkable. These first findings suggest that exsiccation of the stratum corneum is not caused by a damage to barrier lipids.     

Efficacy of corticosteroids in acute experimental irritant contact dermatitis?

Background/aims: Topical corticoids are used to treat irritant contact dermatitis (ICD) in humans. However, their clinical efficacy remains sub judice. This study was designed to assess the efficacy of low- and medium-potency corticosteroids on irritant dermatitis.
Methods: We induced an acute ICD via open application of sodium lauryl sulphate (SLS) on the hands of subjects. The dorsal side of hands was irritated with 10% SLS five times in one day. Once on day 1 and twice daily on days 2–5, 1% hydrocortisone, 0.1% betamethasone-17-valerate and vehicle cream (petrolatum) were applied subsequently. Visual grading, bioengineering techniques and squamometry were used to quantify skin response.
Results: Corticosteroids were found ineffective in treating the surfactant-induced irritant dermatitis when compared with the vehicle and with the untreated control.
Conclusion: The counterintuitive result (in a relatively realistic and robust model) should be interpreted with caution until verified with other irritants of varying physicochemical properties.     

The influence of repeated exposure to surfactants on the human skin as determined by transepidermal water loss and visual scoring

The purpose of this study was to develop a new model for the induction of chronic irritant contact dermatitis, which would reflect well the conditions of daily practice. Various weak irritant agents were tested for irritating potency on the skin and the sensitivity of transepidermal water loss (TEWL) measurements in the detection of early skin changes was also studied. 10 widely used surfactants and 1 solubilizer were applied to the skin of the forearms of healthy volunteers in aqueous solutions of 12.5 millimoles/l for 45 min twice daily for 3 weeks. The effect on the skin was evaluated daily by means of TEWL measurements and by a visual scoring system. Each solution caused an increase in TEWL value over time due to the cumulative irritating action on the epidermal barrier. This increase in TEWL was different for the various solutions, resulting in different mean TEWL values on the last day of the experiment. Thus, it was possible to rank the agents according to irritating potency. This ranking order was the same in almost every individual and remained constant during the 3 weeks. In comparison with the visual scoring system, the TEWL measurements were more sensitive in the detection of early changes in the skin.     

Effect of surfactant mixtures on irritant contact dermatitis potential in man: sodium lauroyl glutamate and sodium lauryl sulphate

Our purpose was to ascertain the irritant contact dermatitis potential of sodium lauroyl glutamate (SLG) and to assess its possible anti-irritating potential in a surfactant mixture on human skin, using visual scores and measurement of transepidermal water loss (TEWL). 15 healthy adult volunteers free of skin disease and with no history of atopic dermatitis were treated with sodium lauryl sulphate (SLS) solution (1%, 0.75%, 0,50%, 0.25%), 1% SLG solution, and 1% surfactant mixture solutions, Ml (75/25), M2 (50/50), M3 (25/50) (SLG/SLS). We applied 100μl of solution using a polypropylene chamber for 24 h. Application sites for each solution were randomized to minimize anatomical bias. We measured baseline TEWL before test solution application. After removal of the patches, each site was visually graded and TEWL recorded with an evaporimeter daily for 4 days. The visual scores and TEWL values of 1% SLG solutions were lower than those of the other test solutions, except the vehicle control (deionized water). 1% surfactant mixture solutions showed lower visual scores and TEWL values than 1% SLS solution. Increase of SLG concentration decreased the visual scores and TEWL values. Comparing the visual scores and TEWL values of Ml and 0.25% SLS solution, M2 and 0.50% SLS solution, and M3 and 0.75% SLS solution. Ml, M2, and M3 showed lower values, although not statistically different. These findings suggest that SLG is a mild surfactant and its utilization can decrease irritation potential in SLS and possibly other mixtures. This model may offer a facile system for screening the surfactant and other mixtures for decreased irritancy potential.