Effect of glove occlusion on human skin (II)

Gloves are indispensable in many occupations. Irritant skin reactions from gloves have, however, been reported. In the present study, the effect of long-term glove occlusion on normal skin (6 h/day for 14 days) was studied and, in addition, the effect of a cotton glove worn under the occlusive glove was also studied. 2 studies were performed (studies A and B). Study A: 19 volunteers wore an occlusive glove on normal skin 6 h/day for 14 days. They wore the glove on one hand only, while the other hand served as control. Study B: 18 volunteers wore occlusive gloves on both hands on normal skin. A cotton glove was worn under the occlusive glove on either the left or the right hand. Skin barrier function was evaluated by measurement of transepidermal water loss (TEWL) (Evaporimeter) skin hydration by electrical capacitance (Corneometer) and inflammation by erythema index (Derma-Spectrometer). The gloves used were hypoallergenic non-latex gloves. Results Study A: glove occlusion on normal skin 6 h/day for 14 days had a significant negative effect on skin barrier function, as measured by TEWL. Study B: the negative effect on skin barrier function from occlusive gloves was prevented by the use of a cotton glove. It is concluded that gloves may be a substantial factor in the pathogenesis of cumulative irritant contact dermatitis, and that recommendations as to their use are important.     

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 glove occlusion on human skin

Skin harrier function was studied after use of occlusive gloves on normal and compromised skin. 2 studies were performed (Study A and B), and the effects were evaluated by non-invasive methods. Participants in the studies were instructed to wear an occlusive glove on one hand, while the other hand served as control. The gloves used were hypoallergenic, non-latex. Study A: 20 volunteers wore a glove on normal skin 6 h/day for 3 days. Study B: 20 volunteers wore a glove on sodium fauryl sulfa lei S LSI-compromised skin 6 h/day for 3 days. Skin harrier function was evaluated by measurement of transepidermal water loss (TEWL) (Evaporimeter), skin hydration by electrical capacitance (Corneometer) and inflammation was evaluated by erythema index (DermaSpetrometer). Results: Study A. Glove occlusion on normal skin 6 h/day for 3 days caused no significant influence on the water barrier function. Study B: Glove occlusion on SLS-compromised skin for the same period of time had a significantly negative effect on the water barrier function. It is concluded that occlusion may be an additional factor in the pathogenesis of cumulative irritant contact dermatitis.     

Sodium lauryl sulphate penetration in an in vitro model using human skin

Because of their ability to impair the skin barrier function, detergents constitute a major risk factor for the development of irritant contact dermatitis. Sodium lauryl sulphate (SLS) is a commonly used detergent for experimental studies within the area of irritant contact dermatitis. In the present study, penetration of S³⁵-labelled SLS was studied in an in vitro model using human cadaver skin. The investigations showed that SLS is capable of permeating the skin barrier when applied under occlusion. SLS could be detected in the dermis and the amount of SLS found here was shown to depend on the dose of SLS applied on the skin. Penetration of SLS continued after removal of the SLS applied as a patch test on the skin surface. Considerable inter-individual variation in the penetration of SLS was demonstrated between different donors.     

Additive impairment of the barrier function by mechanical irritation, occlusion and sodium lauryl sulphate in vivo

BACKGROUND: The interaction between potential irritants in the workplace might be important because workers are not usually exposed to a single irritant, but to multiple potentially harmful substances. Physical irritant contact dermatitis caused by friction or mechanical abrasion is a common occupational dermatosis. Prolonged water exposure by occlusion is also common in the workplace. Several studies have revealed the negative effect of the common anionic detergent sodium lauryl sulphate (SLS) on permeability barrier function. OBJECTIVES: To study the additive impairment of permeability barrier function by mechanical irritation combined with 0.5% SLS or prolonged water exposure by occlusion, as models of mild irritation. METHODS: The volar forearms of 20 healthy volunteers were exposed to mechanical irritation and occlusion with water or 0.5% SLS for four consecutive days in a combined tandem repeated irritation test (TRIT). Permeability barrier function was measured with a Tewameter TM 210. Irritation was assessed with a Chromameter CR 300 and a visual score. RESULTS: Barrier disruption in our model was rated as follows: occlusion with SLS and mechanical irritation > occlusion with SLS > occlusion with water and mechanical irritation > mechanical irritation and occlusion with water > occlusion with a glove and mechanical irritation > mechanical irritation > occlusion with water. Barrier disruption caused by occlusion or mechanical irritation was enhanced by the tandem application. The choice of irritant under occlusion, time of occlusion and order of tandem application all affected the degree of barrier disruption. Evaporimetry was able to detect early stages in the development of an irritant reaction before it became visible. Chromametry was not able to detect this early response. CONCLUSIONS: Physical irritants (friction, abrasive grains, occlusion) and detergents such as SLS represent a significant irritation risk and should be minimized, especially when acting together, as shown in our TRIT model.     

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.     

Skin irritant reactivity following experimental cumulative irritant contact dermatitis

Despite the frequency of irritant contact dermatitis, very little is known about the duration of barrier function impairment following cumulative irritant contact dermatitis. We studied post-irritation irritant reactivity by assessing the response to SLS irritation in previously irritated sites. Cumulative irritant contact dermatitis was induced on the forearms of 15 volunteers aged 18 to 50 years by repeated occluded application of 0.5% SLS I h per day over 3 weeks. 3, 6 and 9 weeks later, previously irritated and unirritated control sites were challenged with 2% SLS under occlusion for 23 h. Irritation was assessed by visual scoring, transepidermal water loss (TEWL) as an indicator of epidermal barrier function, and capacitance as a parameter of epidermal water content. While no difference in irritant reactivity between pre-irritated and unirritated sites was observed 3 weeks following irritant contact dermatitis, there was a significant hyporeactivity of previously irritated skin as expressed by clinical scores, TEWL and capacitance at 6 and 9 weeks. Our results indicate that epidermal barrier function remains altered even 9 weeks after cumulative irritant contact dermatitis. With regard to patch testing, post-irritation hyporeactivity might be a cause of false-negative tests on previously irritated sites.     

Abnormal epidermal barrier in the pathogenesis of contact dermatitis

A crucial role of the epidermal permeability barrier is obvious in contact dermatitis. An intact skin barrier prevents the penetration of harmful substances into the skin. Irritants and allergens that stay on the skin surface and come into contact with the stratum corneum only do not harm the skin. After disruption of the skin barrier, however, irritants may penetrate into the living epidermal layers, injure the keratinocyte membrane, and release cytokines, which leads to inflammation and to irritant contact dermatitis. The skin barrier is often disrupted by chronic exposure to water plus detergents, solvents, or other irritants. A disrupted barrier in irritant contact dermatitis also allows for the penetration of allergens. Allergens may come into contact with Langerhans and T cells, induce immunological reactions, and cause inflammation, which results in allergic contact dermatitis. Treatments in contact dermatitis should restore the skin barrier to prevent relapse of the disease. Topical corticosteroids, most often used in treating contact dermatitis, reduce immunological reactions and inflammation but do not lead to a complete barrier repair. Skin barrier repair is more complete after treatment with calcineurin inhibitors and bland lipid-based emollient; therefore, these preparations should be preferred for long-term treatment of contact dermatitis.     

The use of a measure of acute irritation to predict the outcome of repeated usage of hand soap products

Background Healthcare‐associated infection is an important worldwide problem that could be reduced by better hand hygiene practice. However, an increasing number of healthcare workers are experiencing irritant contact dermatitis of the hands as a result of repeated hand washing. This may lead to a reduced level of compliance with regard to hand hygiene. Objectives To assess whether a measure of acute irritation by hand soaps could predict the effects of repeated usage over a 2‐week period. Methods In a double‐blind, randomized comparison study, the comparative irritation potential of four different hand soaps was assessed over a 24‐h treatment period. The effect of repeated hand washing with the hand soap products over a 2‐week period in healthy adult volunteers on skin barrier function was then determined by assessment of transepidermal water loss (TEWL), epidermal hydration and a visual assessment using the Hand Eczema Severity Index (HECSI) at days 0, 7 and 14. Results A total of 121 subjects from the 123 recruited completed phase 1 of the study. All four products were seen to be significantly different from each other in terms of the irritant reaction observed and all products resulted in a significantly higher irritation compared with the no‐treatment control. Seventy‐nine of the initial 121 subjects were then enrolled into the repeated usage study. A statistically significant worsening of the clinical condition of the skin as measured by HECSI was seen from baseline to day 14 in those subjects repeatedly washing their hands with two of the four soap products (products C and D) with P‐values of 0·02 and 0·01, respectively. Subclinical assessment of the skin barrier function by measuring epidermal hydration was significantly increased from baseline to day 7 after repeated hand washing with products A, B and D but overall no significant change was seen in all four products tested by day 14. A statistically significant increase in TEWL at day 14 was seen for product A (P = 0·02) indicating a worsening of skin barrier function. This effect was also seen initially for product D at day 7 although this was then lost at day 14. Further regression analysis was then performed to see if the acute irritant test data for each product correlated with the skin barrier data from the repeated usage component of the study. This showed that the results of acute irritant testing of the individual products did not predict the results of chronic use of hand soaps. Conclusions The results from phase 2 of our study confirm the work of previous studies that show that regular exposure to irritants in daily life leads to stratum corneum damage and impairment of the skin barrier. Although significant differences were seen between the products in phase 1 of the study, regression analysis showed that the results of patch testing of the individual products did not predict the results of chronic use of hand soaps. When designing a study to assess the effects of cumulative use of a product on the skin, the study should mirror the use conditions of the product as closely as possible.     

Skin barrier response to occlusion of healthy and irritated skin: Differences in trans‐epidermal water loss,erythema and stratum corneum lipids

Background. Occlusion of the skin is a risk factor for development of irritant contact dermatitis. Occlusion may, however, have a positive effect on skin healing. No consensus on the effect of occlusion has been reached. Objectives. To investigate skin barrier response to occlusion on intact and damaged skin. Methods. In study A, the response to occlusion (nitrile glove material) for either 8 hr daily for 7 days or for 72 consecutive hours, respectively, was determined and compared with that of non‐occluded skin. In study B, the response to occlusion of for 72 consecutive hours of skin that had been damaged by either sodium lauryl sulfate (SLS) or tape stripping, respectively, was determined and compared with that of to non‐occluded pre‐damaged skin. Skin barrier function was assessed by measurements of trans‐epidermal water loss (TEWL) and erythema. In study A, stratum corneum lipids were analysed. Results. Occlusion of healthy skin did not significantly influence skin barrier function, ceramide profile or the ceramide/cholesterol ratio. Occlusion of the skin after SLS irritation resulted in higher TEWL than in the control (P = 0.049). Occlusion of the skin after tape stripping resulted in lower TEWL than in control skin (P = 0.007). Conclusions. A week of occlusion did not significantly affect healthy skin, but was found to decrease healing of SLS‐damaged skin, and to improve healing of tape‐stripped skin.     

The combined use of moisturizers and occlusive gloves: an experimental study.

BACKGROUND: Protective gloves are used in the workplace to protect the hands from occupational hazards, but side effects from glove use are frequently reported. Among these side effects, irritant skin reactions are common. OBJECTIVE: The present study was undertaken to investigate whether applying a moisturizer to compromised skin before wearing an occlusive glove could reduce skin irritation. METHODS: Healthy volunteers had both hands immersed in a sodium lauryl sulfate solution twice daily for 2 days. After each immersion, one hand had a moisturizer applied and both hands were put in occlusive gloves for 2 hours. Skin barrier function was evaluated by transepidermal water loss, skin hydration was measured by electrical capacitance and inflammation was evaluated by colorimetry. RESULTS: The moisturizer had a statistically significant positive effect on both the water barrier function and the hydration level of the skin. Although not statistically significant, less inflammation was observed on the moisturizer-treated hand. CONCLUSION: The findings suggest that use of a moisturizer under an occlusive glove may diminish irritation from exposure to a detergent followed by glove wearing.     

The association of smoking with contact dermatitis and hand eczema – a review

Given the high prevalence of allergic contact dermatitis (ACD), irritant contact dermatitis (ICD), hand eczema (HE), and smoking, and the impact that smoking has on skin disease, the authors reviewed the existing literature to assess the association between smoking and contact dermatitis or hand eczema. Using the PubMed and SCOPUS databases, a literature search identified articles related to allergic contact dermatitis, irritant contact dermatitis, and hand eczema and a possible association with smoking. The search period included articles prior to and including April 2016. Seven of eight articles described a positive relationship between smoking and allergic or irritant contact dermatitis, while nine of nineteen articles found a positive association between smoking and hand eczema. Published studies document that smoking may be an important risk factor for both allergic and irritant contact dermatitis as well as hand eczema.     

Occupational irritant and allergic contact dermatitis among healthcare workers

Contact dermatitis is the most frequent occupational dermatosis and non-specific irritants in addition to specific Type IV sensitization are involved. We reviewed our database for data from 1994 to 1998 and selected 360 consecutive patients working in healthcare environments and experiencing contact dermatitis at their hands, wrists and forearms. We found that allergic contact dermatitis and irritant contact dermatitis were considered to be work-related in 16.5% (72/436) and 44.4% (194/436) of diagnoses, respectively. Occupational irritant contact dermatitis is due to exposure to a wide range of irritants in the workplace, such as soaps, solvents, cleansers and protective gloves, which conspire to remove the surface lipid layer and/or produce cellular damage. In this study the major relevant aetiological agents that induced occupational allergic contact dermatitis were: nickel sulphate (41 patch positivities), components of disinfectants [glutaraldehyde (5) and benzalkonium chloride (7)] and rubber chemicals [thiuram mix (15), carba mix (9) and tetramethylthiuram monosulphide (6)]. The best treatment for allergic contact dermatitis is to avoid those allergens causing the rash. Whenever this is not possible, contact with them needs to be reduced using properly selected protective gloves. Finally, subjects with atopic dermatitis should avoid 'wet work' and contact with irritants, because atopic dermatitis is significantly associated with irritant contact dermatitis.     

Air flow at different temperatures increases sodium lauryl sulphate-induced barrier disruption and irritation in vivo

BACKGROUND: Combined exposure to dry climatic conditions and local heat sources together with detergents represents a common workplace situation. These conditions may support the induction of chronic barrier disruption leading subsequently to irritant contact dermatitis (ICD). OBJECTIVES: To test the irritant and barrier disrupting properties of air flow at different temperatures and velocities. METHODS: Using noninvasive biophysical measurements such as transepidermal water loss (TEWL) (TM 210; Courage & Khazaka, Cologne, Germany) we assessed the effects of short-term exposure to air flow at different temperatures (24 degrees C and 43 degrees C) in combination with sodium lauryl sulphate (SLS) 0.5% on the skin of 20 healthy volunteers in a tandem repeated irritation test. Chromametry was used to control the accuracy of the SLS irritation model. RESULTS: In our study air flow alone did not lead to a significant increase in TEWL values. Sequential treatment with air flow and SLS led to an impairment of barrier function and irritation stronger than that produced by SLS alone. The two different air flow temperatures led to different skin temperatures but had no influence on permeability barrier function. CONCLUSIONS: Warm air flow has an additional effect on the SLS-induced barrier disruption in a tandem irritation test with sequential exposure to SLS/air flow. This combination is suspected to promote ICD in workplace and household situations, especially in short-term applications as tested in our model.     

Glove powder affects skin roughness, one parameter of skin irritation

Most patients with immediate-type-hyper sensitivity to natural rubber latex (NRL) give a history of hand eczema. Susceptibility to allergens is increased by irritant hand eczema due to damage to the skin barrier. Therefore, especially for employees in medical or paramedical professions, reduction in skin irritation is of importance. The present study reports the effect of glove powder on skin roughness, one feature of skin irritancy. Skin replicas, performed before and after wearing different types of gloves, were evaluated by laser profilometry. Significant alteration of skin roughness was evident and determined by different factors. Use of unpowdered Biogel gloves on prepowdered hands results in an increase in skin roughness, in contrast to the use of Biogel gloves on hands without any pre-application. On the other hand, powdered Manex neoderm gloves show no influence on the skin structure, whereas powdered Peha taft gloves also increase the roughness of the skin. Other potential candidates causing skin morphology alteration could be the glove pH, rubber chemicals with irritant potential and other characteristics of gloves, which are already under investigation.     

Undesirable effects from latex gloves in hospital health-care personnel

The high incidence of occupational hand dermatitis in hospital employees and the increased number of reports on cutaneous, mucosal and systemic reactions connected with a widespread USE: OF GLOVES induced us to investigate the prevalence of undesirable effects caused by latex gloves and the possible risk factors. We distributed a self-administered questionnaire, elaborated by us. to 1030 Perugia Monteluce Hospital employees who usually used latex gloves at work. The questionnaire was returned by 922 (476 females and 446 males; mean age. 38.7 years). The subjects who reported atopy and/or undesirable glove reactions were interviewed and clinically examined. Of these, 128 (13.9%) had presented or still had glove problems and therefore were submitted to skin tests (patch and prick tests) and when negative, to use test. Our results showed that the large majority of skin complaints from gloves was caused by irritation rather than by allergy. Predisposing factors of irritant contact dermatitis (CD), which was present in 13.1% of the subjects investigated, were female sex. age under 31 years, cleaning activity mainly when carried out in the Held of internal medicine, and atopie constitution. The most common causative factors, investigated with two substitute latex gloves in 64 of the 120 patients affected by irritant CD, were cornstarch powder and perhaps latex proteins. Even if allergic skin disorders from latex gloves were rare in our unselected group (allergic CD: 0.5%-, contact urticaria: 0.3%), more attention should be given to IgE-mediated disorders since they may be a life threatening problem.     

Skin absorption through atopic dermatitis skin: a systematic review

Patients with atopic dermatitis (AD) have skin barrier impairment in both lesional and nonlesional skin. They are typically exposed daily to emollients and intermittently to topical anti‐inflammatory medicaments, thereby increasing the risk of developing contact allergy and systemic exposure to chemical ingredients found in these topical preparations. We systematically searched for studies that investigated skin absorption of various penetrants, including medicaments, in patients with AD, but also in animals with experimentally‐induced dermatitis. We identified 40 articles: 11 human studies examining model penetrants, 26 human studies examining AD drugs, and three animal studies. We conclude that patients with AD have almost twofold increased skin absorption compared with healthy controls. There is a need for well‐designed epidemiological and dermatopharmacokinetic studies that examine to what extent AD causes patients to be systemically exposed to chemicals compared with nonatopic dermatitis.     

The use of different concentrations of betaine as a reducing irritation agent in soaps monitored visually and non-invasively

Background/aims: Products containing detergents can damage the skin and give rise to irritant contact dermatitis. Therefore, attempts have been made to find less irritating detergents as well as substances decreasing undesired side-effects of detergents, and a novel approach is offered by betaine. The aim of the study has been to determine the irritating properties of some liquid soaps for personal hygiene and to map the effect of different concentrations of betaine using electrical impedance, trans -epidermal water loss and visual inspection.
Methods: Twenty-eight healthy subjects were patch tested with different commercial soaps with and without betaine and sodium lauryl sulphate on both volar forearms for 24 h. A site with distilled water and an unoccluded area were used as references. Responses of the skin reactions were evaluated by visual inspection and by measuring trans -epidermal water loss and electrical impedance before application and 24 h after removal of the chambers.
Results/conclusions: Significant skin reactions were found for all soaps tested but the soaps containing betaine were the least irritating. However, the skin irritation did not decrease with increasing concentrations of betaine in the tested range. On the whole the differences between the products were not large. The non-invasive methods used were more sensitive than visual assessment for evaluation of invisible or barely visible skin responses.     

P60Permeability of gloves to plant allergens

Objective:  Study permeability of gloves to plant allergens, therefore evaluating glove efficacy for hand protection.
Material and methods:  We studied 20 female patients (aged 21–71; mean 45,1 years) with ACD from plants, 10 allergic to diallyl disulfide (DAD) from Allium sativa, 8 allergic to alpha‐methylene‐gama‐butyrolactone (AMGBL) from Alstroemeria ligtu and 2 allergic to primin from Primula obconica. Patch testing was performed applying the allergens, for 24 or 48 h, directly on the skin and over fragments of different gloves: domestic rubber gloves (RG), nitrile latex gloves (NG), vinyl gloves (VG), surgical latex gloves (LG) and polyethylene gloves (PG).
Results:  VG, PG or LG gloves offered no protection for these 3 allergens. With RG and NG gloves, DAD reactivity was abolished or significantly reduced, respectively, in 5 and 7 cases. Reactivity to AMGBL wasn't abolished by any glove material. NG abolished skin reactivity to primin; RG was efficacious only in 1 patient.
Conclusions:  Advising gloves in patients with ACD from plants is difficult, as allergen permeability through gloves associated with occlusion may intensify the dermatitis, as occurred during skin testing. Nitrile latex gloves may protect from primin and garlic dermatitis, whereas they are not helpful for manipulating Alstroemeria. Although exposure time in this study is higher than in real life, results show interesting data on glove permeability to these plant allergens and support our patients' complaints that gloves didn't protect them.     

Hydrogel barrier/repair creams and contact dermatitis.

BACKGROUND: Barrier creams are important to protect the skin in occupations with chemical exposure. The value of hydrogels in barrier creams has never been studied. OBJECTIVE: The purpose of this study was to evaluate the current technology in barrier cream formulation and explore the utility of hygrogels in skin protection. METHODS: A total of 80 men, women, and children between the ages of newborn to 80 years >were studied with the following dermatologic conditions: household hand dermatitis (21), occupational hand dermatitis (18), latex glove irritant contact dermatitis (9), diaper dermatitis (5), cutaneous wounds (17), and allergic contact dermatitis (ACD) (10). In this study, the investigators used a split body approach, in a double-blind randomized fashion, where one body site was treated with a traditional petrolatum-based cream while the other body site was treated with a hydrogel-based barrier/repair cream. Both subject and investigator assessments were recorded by questionnaire. RESULTS: The hydrogel barrier/repair cream showed better skin improvement than the petrolatum-based cream in both subject assessment (62%, P =.0048) and investigator assessment (75%, P =.0000003). CONCLUSION: Hydrogel barrier/repair creams might represent a new, effective approach to skin protection.