A novel in vivo model in guinea pigs for dry skin syndrome

Background/aims: The lack of a suitable, validated animal model for the comparison of the pharmacological effectiveness of known and potential moisturizers in the treatment of “dry skin syndrome” led us to develop such an in vivo model. Methods: “Dry skin syndrome” was induced in guinea pigs by daily application of 2% sodium lauryl sulphate (SLS) in deionized water on one of the two shaved flanks for three consecutive days. After ascertaining skin dryness, that side was treated with an agent for 6 days. The in vivo humectant effect was measured by a Corneometer CM 825^®, erythema was measured by a Mexameter MX 16^®. In some cases histological studies were carried out. Results: The treatment with the 2% SLS led to a consistent “dry skin syndrome” for 2 weeks. Glycerol, Vaseline, urea and ammonium lactate treatments validated the model, since the Corneometer CM 825^® readings of the treated dry side was equal to that of the control untreated side after 1 week of treatment. Mexameter MX 16^® measurements showed abolishment of the erythema by glycerol only. Histological study showed that SLS treatment creates acanthosis that is partially reversed by Vaseline and fully reversed by glycerol treatment. Conclusion: The guinea pig dry skin model is a relevant model of the human “dry skin syndrome”. The instrumental results combined with the histological findings indicate that erythema measurements are relevant for the determination of curative effect.     

Hautschutz‐ oder Hautregenerationscreme? Der Halbseitenversuch in der Bewertung eines hautpflegenden Externums

Summary: It is often said that moisturizers should be used both during and after work with skin irritating substances. However, many products are lacking experimental proof to prevent from skin irritation or to support the regeneration of the skin. Taking a protection cream as an example, we present a test design that enables us to discriminate between a barrier‐supporting effect and a moisturizing effect (“skin recovery cream”) of this product. 30 volunteers performed a repetitive washing on both forearms with a sodium lauryl sulfate solution. One forearm was treated with the cream either 30 minutes prior to washing (15 volunteers) or 30 minutes after washing (15 volunteers).
The other forearm was not treated and served as a control. On the treated forearms we found a lower increase in transepidermal water loss and a higher skin hydration as compared to the untreated arm. Treatment after washing was significantly more effective than treatment before washing.
Hence, this test design was able to discriminate between the barrier and the regeneration effect of the cream. The tested protection cream was most effective as a skin recovery cream.     

The connection between in vitro water uptake and in vivo skin moisturization

Background/purpose: Humectancy or hygroscopy is the water absorption tendency of a substance from the surroundings. Our interest, from the clinical point of view, consists of correlating this tendency in vitro and its effect in vivo for the development of drugs and formulations for the treatment of dry skin syndrome or diseases accompanied by dry skin. Method: In vitro, water absorption was measured using the comparative isopiestic method. This method is based on bringing the vapor of the water to isothermal equilibrium between a reference system and the material to be studied. The in vivo model on guinea‐pigs for the dry skin syndrome tested the therapeutic ability of mono‐, di‐ and tri‐glycerols to provide moisture to dry skin leading to healing. The moisture content in the stratum corneum was measured with a Corneometer CM 825^® PC that measures merely the presence of high dielectric material (humectant or water), whereas the Mexameter MX 16^® measures a pathological parameter – the erythema. Results: Adding hydroxyl groups to a consecutive set of polyhydroxyalkanes increases the humectancy of the polyols in vitro. This elevation was found to be linear at low relative humidities (Relative humidity=31.9% and 37°C). In vivo, moisture was returned to normal within a week in all three groups. However, only glycerol managed to abolish the erythema within 7 days. Conclusion: A rise in water absorption ability in vitro, at a rate of about 0.25 mol water per hydroxyl group was revealed in a consecutive set of glycerols (mono‐, di‐ and tri‐glycerols). One would expect that the better humectant is a material, i.e. in which the higher its physical ability to hold water in vitro the more effective it will be in recovering skin dryness. We have found, however, that glycerol, which has the lowest humectant activity in vitro, from the set of glycerols, di‐ and tri‐glycerol, has been proven to be the best for eliminating the signs of skin dryness. Accordingly, we propose to distinguish between the in vitro humectancy (i.e. the water uptake of a material), and its in vivo moisturizing effect, i.e. its ability to cure skin dryness and erythema. This finding supports our conclusion that the connection between in vitro humectancy and in vivo moisturization is not a simple correlation.     

Silk sericin as a moisturizer: an in vivo study

Background Excessive transepidermal water loss (TEWL) is the one of the causes of dry skin, and skin moisturizers have been used to overcome it. Aim The purpose of this research was to study the moisturizing effect of sericin, a silk protein. Because silk sericin has resemblance with the natural moisturizing factor (NMF), it has been studied for its application in skin cosmetics. Methods Sericin gels were prepared using sericin solution and with pluronic and carbopol as stabilizers. The gels were applied on the skin of healthy human volunteers and its moisturizing efficiency was evaluated by measuring the skin hydroxyproline content, impedance, TEWL, and scanning electron microscopy (SEM) results. Results Decrease in skin impedance, increase in hydroxyproline level, and hydration of epidermal cells revealed the moisturizing effect of sericin, whereas decrease in the value of TEWL may be attributed to occlusive effect, which prevents water loss from the upper layer of the skin. Skin surface topography revealed the smoothness of the upper layer of the skin as a result of moisturization. Conclusion Increase in the intrinsic moisturization of skin by sericin may be attributed to restoration of the amino acids and its occlusive effect. Thus, it would become a promising and important moisturizing ingredient in moisturizing formulations.     

Improvement in skin barrier function in patients with atopic dermatitis after treatment with a moisturizing cream (Canoderm)

Patients with atopic skin show a defective barrier function both in rough and in clinically normal skin, with an increasing risk of developing contact dermatitis. Moisturizing creams are often used in the treatment of dry skin. The purpose of this study was to investigate the influence of treatment with a urea-containing moisturizer on the barrier properties of atopic skin. Fifteen patients with atopic dermatitis treated one of their forearms twice daily for 20 days with a moisturizing cream. Skin capacitance and transepidermal water loss (TEWL) were measured at the start of the study and after 10 and 20 days. On day 21 the skin was exposed to sodium lauryl sulphate (SLS) and on day 22 the irritant reaction was measured non-invasively. Skin capacitance was significantly increased by the treatment, indicating increased skin hydration. The water barrier function, as reflected by TEWL values, tended to improve (P = 0.07), and the skin susceptibility to SLS was significantly reduced, as measured by TEWL and superficial skin blood flow (P < 0.05). Thus, it seems that certain moisturizers could improve skin barrier function in atopics and reduce skin susceptibility to irritants. The mechanism and the clinical relevance need further investigation.     

Effect of moisturizers on epidermal barrier function

A daily moisturizing routine is a vital part of the management of patients with atopic dermatitis and other dry skin conditions. The composition of the moisturizer determines whether the treatment strengthens or deteriorates the skin barrier function, which may have consequences for the outcome of the dermatitis. One might expect that a patient's impaired skin barrier function should improve in association with a reduction in the clinical signs of dryness. Despite visible relief of the dryness symptoms, however, the abnormal transepidermal water loss has been reported to remain high, or even to increase under certain regimens, whereas other moisturizers improve skin barrier function. Differing outcomes have also been reported in healthy skin: some moisturizers produce deterioration in skin barrier function and others improve the skin. Possible targets for barrier-influencing moisturizing creams include the intercellular lipid bilayers, where the fraction of lipids forming a fluid phase might be changed due to compositional or organizational changes. Other targets are the projected size of the corneocytes or the thickness of the stratum corneum. Moisturizers with barrier-improving properties may delay relapse of dermatitis in patients with atopic dermatitis. In a worst-case scenario, treatment with moisturizing creams could increase the risks of dermatitis and asthma.     

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     

Effect of moisturizers on skin susceptibility to irritants

Moisturizers are used for the treatment of dry and irritated skin. The benefit of moisturizers when used on normal skin has recently been challenged, since an earlier study indicated that the increased hydration that follows long-term use of moisturizers on normal skin may facilitate penetration of irritants. The aim of the present study was to evaluate short-term use of 2 different moisturizers used on normal skin: cream A (high lipid content) and B (moderate/low lipid content). Nineteen healthy volunteers applied the moisturizers on the upper arm/forearm 3 times daily for 5 days, while the other upper arm/forearm served as symmetrical control. The day after moisturizer treatment was stopped the skin was challenged with a patch test of sodium lauryl sulphate. Skin reactions were evaluated by bioengineering measuring methods and clinical scoring. Skin response to sodium lauryl sulphate was increased on moisturizer-treated arms compared to controls for one of the moisturizer (cream A), while this was not statistically significant for the other moisturizer (cream B). Data confirm previous indications that some moisturizers when used on normal skin may increase skin susceptibility to irritants.     

Assessment of moisturizers and barrier function restoration using dynamic methods

Background/purpose: Dynamic methods, such as the mathematical modelling of the transepidermal water loss curves that result from a plastic occlusion stress test (POST), enable the complete characterization of the dynamic water balance established between the deep and the superficial skin structures. Previous studies have indicated that this methodology was able to detect impaired barrier function and differentiate normal and dry skin. The objective of the present study is to apply the discriminative capacity of the model to the efficacy testing of moisturizing products.
Methods: A moisturizing cream containing urea was applied for 2 weeks to the lower leg of volunteers with dry skin. After this period, a POST was performed in the treated and control untreated site and a mathematical model was adjusted to the resulting desorption curves.
Results: Results indicate that, after treatment of the skin with the cream for 2 weeks, statistically different kinetic parameters are obtained in the treated site, which suggests an improvement in the water dynamic balance and skin barrier. The data generated by this study was compared with that obtained in a similar investigation that was performed a year earlier. Analysis of the dispersion of results indicates that the method has good reproducibility.
Conclusions: These findings confirm that the method has enough sensitivity to assess in vivo the effect of moisturizers on human skin, and also that this evaluation can be performed in a shorter period than that required by the regression method. This methodology can also be considered more informative, because the analysis of the different parameters obtained by the model is indicative of the mechanism of action of the product applied to the skin.     

Efficacy of the combined use of a facial cleanser and moisturizers for the care of mild acne patients with sensitive skin

Acne is a common skin disease that involves the seborrheic area of the face and results from the obstruction of hair follicles followed by inflammation. Careful face washing helps to improve and prevent acne; however, intensive washing has a risk of inducing skin barrier impairment and dry skin, especially in sensitive skin. We hypothesized that skin care combining mild skin cleansing and intensive moisturizing (“combination skin care”) may be effective in the care of acne in subjects with dry skin and/or sensitive skin. We developed a combination skin care with a weakly acidic foaming facial skin cleanser based on a mild detergent, an aqueous lotion with eucalyptus extract and a moisturizing gel containing pseudo‐ceramide and eucalyptus extract. To optimize an ideal facial skin care system for mild acne on sensitive skin, we performed a 4‐week clinical trial with 29 post‐adolescent Japanese women with mild acne with dry and sensitive skin. The acne significantly decreased after this trial accompanied by the improvement of dry skin, a significantly increased endogenous ceramide level in the stratum corneum and an elongated alkyl chain length of the non‐hydroxy acyl sphingosine type ceramide. No adverse events due to the test samples were observed. Based on diagnosis by a dermatologist, 97% of the subjects found the combination skin care to be “useful” or “slightly useful”. Based on these findings, the combined use of a facial skin cleanser and moisturizers is safe and effective for the care of acne in post‐adolescent Japanese women with sensitive skin.     

Role of Topical Emollients and Moisturizers in the Treatment of Dry Skin Barrier Disorders

Emollients and moisturizing creams are used to break the dry skin cycle and to maintain the smoothness of the skin. The term 'moisturizer' is often used synonymously with emollient, but moisturizers often contain humectants in order to hydrate the stratum corneum. Dryness is frequently linked to an impaired barrier function observed, for example, in atopic skin, psoriasis, ichthyosis, and contact dermatitis. Dryness and skin barrier disorders are not a single entity, but are characterized by differences in chemistry and morphology in the epidermis. Large differences also exist between moisturizing creams. Moisturizers have multiple functions apart from moistening the skin. Similar to other actives, the efficacy is likely to depend on the dosage, where compliance is a great challenge faced in the management of skin diseases. Strong odor from ingredients and greasy compositions may be disagreeable to the patients. Furthermore, low pH and sensory reactions, from lactic acid and urea for example, may reduce patient acceptance. Once applied to the skin, the ingredients can stay on the surface, be absorbed into the skin, be metabolized, or disappear from the surface by evaporation, sloughing off, or by contact with other materials. In addition to substances considered as actives, e.g. fats and humectants, moisturizers contain substances conventionally considered as excipients (e.g. emulsifiers, antioxidants, preservatives). Recent findings indicate that actives and excipients may have more pronounced effects in the skin than previously considered. Some formulations may deteriorate the skin condition, whereas others improve the clinical appearance and skin barrier function. For example, emulsifiers may weaken the barrier. On the other hand, petrolatum has an immediate barrier-repairing effect in delipidized stratum corneum. Moreover, one ceramide-dominant lipid mixture improved atopic dermatitis and decreased transepidermal water loss (TEWL) in an open-label study in children. In double-blind studies moisturizers with urea have been shown to reduce TEWL in atopic and ichthyotic patients. Urea also makes normal and atopic skin less susceptible against irritation to sodium laurilsulfate. Treatments improving the barrier function may reduce the likelihood of further aggravation of the disease. In order to have optimum effect it is conceivable that moisturizers should be tailored with respect to the epidermal abnormality. New biochemical approaches and non-invasive instruments will increase our understanding of skin barrier disorders and facilitate optimum treatments. The chemistry and function of dry skin and moisturizers is a challenging subject for the practicing dermatologist, as well as for the chemist developing these agents in the pharmaceutical/cosmetic industry.     

Measuring the effects of topical moisturizers on changes in stratum corneum thickness, water gradients and hydration in vivo

Background Moisturizers are the most commonly used topically applied product for the treatment of dry skin conditions. They affect many properties and functions of the stratum corneum but some moisturizers have been reported to be detrimental to barrier function. Stratum corneum barrier function is a composite of its total structure and thickness but few studies have taken this into account. As a biosensor, the stratum corneum (SC) will change its structure in response to treatment and a swelling effect has been clearly demonstrated by skin hydration. Recently several moisturizing agents have been shown to have an effect on SC swelling behaviour with conflicting results. However, there is a paucity of data reported for measuring the effects of long‐term usage of moisturizers on SC thickness in vivo as, until recently, traditional techniques did not have the resolution to measure the effects of moisturizers on nonpalmoplantar body sites. The development of confocal Raman spectroscopy for use in human subjects provides noninvasive, real‐time, in vivo measurement of SC water concentration profiles and we have also used this state of the art equipment to measure the effect of the long‐term use of moisturizers on SC thickness for the first time. Objectives To validate the use of confocal Raman spectroscopy (CRS) to measure SC thickness and then use it to investigate the short‐ and long‐term effects of moisturizers (one of which is known to improve SC barrier function) on SC thickness, water gradients and hydration. Methods Two studies were conducted: (i) to validate the use of CRS for measuring SC thickness through comparison with optical coherence tomography (OCT); and (ii) once validated to use CRS to measure the long‐term effects of three commercially available moisturizers (A, B, C) on SC thickness and water gradients, together with total hydration, over a 3‐week period (2 weeks of treatment and 1 week regression) and compare the spectroscopy‐derived hydration value with instrumentally derived capacitance hydration values. Results (i) A strong, positive correlation in SC thickness was obtained between CRS and OCT (OCT‐derived thickness = 0·96 × CRS‐derived thickness, r² = 0·93; P <0·0001). OCT was shown, however, to have a lower resolution than CRS in distinguishing SC thickness on thinner nonpalmoplantar body sites. Using the CRS method, differences in SC thickness were readily apparent on different body sites (cheek 12·8 ± 0·9 μm, volar forearm 18·0 ± 3·9 μm, leg 22·0 ± 6·9 μm). (ii) Examining the effects of moisturizers in a blinded, randomized 3‐week study in human volunteers (n = 14) demonstrated that only one commercially available formulation (A) changed SC water gradients, thickness and hydration as measured by CRS. These hydration data did not directly correlate with capacitance hydration values. Conclusions (i) In vivo CRS was validated as a technique to measure SC thickness on both palmoplantar and, particularly, on nonpalmoplantar skin sites. (ii) Moisturizers improve skin moisturization but in this study only formulation A improved SC thickness, water gradients and hydration as measured by CRS. We hypothesize that this was due to compositional differences between the products. We believe that niacinamide (nicotinamide, vitamin B₃) is probably contributing significantly to this effect, as it has been proven to increase epidermal lipogenesis and SC barrier function in other studies. These results show that by using CRS, we were able for the first time to determine the effect of moisturizer on multiple SC barrier endpoints including SC thickness, and water content as a function of depth and total SC water content.     

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.     

Studies on constituents of moisturizers: water-binding properties of urea and NaCl in aqueous solutions.

A water content of about 10% in the horny layer is necessary for softness and pliability of this part of the epidermis. In conditions with dry skin, emollients of different types are used. It is important that solid data are collected about the effect of the ingredients of emollients and moisturizers. Urea has since long been used in the treatment of dry skin. In the present report, the mixture of urea and sodium chloride has been analyzed with respect to its effect on the water vapor pressure in concentrated solutions. The depression of the water vapor pressure by NaCl and urea was found to be additive. Thus, the decrease in water vapor pressure in aqueous solution of urea-NaCl mixtures can be estimated by adding the decrease of water vapor pressure caused by dissolving the pure compounds. The results indicate that urea and NaCl in aqueous solution do not interact strongly and are, therefore, compatible in moisturizing preparations. They can, therefore, both be expected to be effective in mixtures giving a better than one of them alone.     

Histological evaluation of dermal tissue remodeling with the 1444‐nm neodymium:yttrium–aluminum–garnet laser in in vivo model

Laser lipolysis has a skin tightening effect by heating the deep dermis, in addition to the removal of fat tissues. The 1444‐nm neodymium:yttrium–aluminum–garnet (Nd:YAG) laser has been expected to be more effective and safe for laser lipolysis, due to higher affinity to fat and water, than 1064‐nm and 1320‐nm wavelengths. The purpose of this study was to evaluate the skin tightening effect of the 1444‐nm Nd:YAG laser through in vivo guinea pig models. The 1444‐nm Nd:YAG laser was used to irradiate shaved dorsal skin of the guinea pigs and compared with controls (no power, only tunneling). Immediately, 1 week, 1 month and 3 months after laser administration, full‐thickness skins were harvested and to evaluate dermal thickness, collagen organization, fibroblast proliferation, and intensity of elastic fibers and mucopolysaccharides, using hematoxylin–eosin, Masson‐trichrome, Verhoeff's stain and Alcian blue stain. Dermal thickness showed an increase with time in all groups. In collagen organization, fibroblast proliferation, and intensity of elastic fibers and mucopolysaccharides, the treatment groups were higher than those of the control group, overall. Our study showed that the 1444‐nm Nd:YAG laser appeared to be effective for the skin tightening effect in in vivo guinea pig models. The 1444‐nm Nd:YAG laser can be used for skin tightening, as well as reduction of fat tissues.     

Lipophilic and hydrophilic moisturizers show different actions on human skin as revealed by cryo scanning electron microscopy

To study the mode of action of moisturizers on human skin, hydrophilic moisturizers in water and neat lipophilic moisturizers were applied on excised skin for 24 h at 32 degrees C. Samples of the treated skin were subsequently visualized in a cryoscanning electron microscope. The stratum corneum (SC) appeared as a region of swollen corneocytes (the swollen region) sandwiched between two layers of relatively dry corneocytes (the upper and lower non-swelling regions respectively). Lipophilic moisturizers increased the water content of the SC, whereas hydrophilic moisturizers can also reduce the water content of the SC. When focusing on the effect of the moisturizers on the three different regions, it was observed that cells in the swelling region are most sensitive to the application of the moisturizers and that the change in SC thickness is most influenced by the change in the thickness of the swelling region. Summarizing, SC cells are not equally sensitive to moisturizer application: centrally located corneocytes are more sensitive than corneocytes in the upper and the lowest regions of the SC.     

Efficacy of skin barrier creams

An animal model for the evaluation of skin protective creams against chemical irritants is described. The irritants were applied daily for 2 weeks to shaved back skin of young guinea pigs: sodium tauryl sulphate (5% aq.: 30 min), sodium hydroxide (0,5% aq.; 2 min). and toluene (20'i. eth.; 2 mint. "The harrier cream was applied 2 h prior to and immediately after exposure to the irritant. Control animals were treated with the irritant only. The irritant reaction was scored on a 4–point scale for erythema and quantified with regard to transepidennal water loss (TEWL) by evaporime-try and skin blood flow volume (BFV) by laser Doppler velocimetry. A total of 90 guinea pigs, consisting of" individual panels of 5 to 10 animals, was tested. While one barrier cream (Slokoderm) significantly suppressed the irritation due 10 sodium lauryl sulphate and toluene, the other (Contra-Alkalh failed to do so and even aggravated the response, which was particularly evident with sodium hydroxide. This model may be useful in developing more effective barrier creams.     

Changes in skin barrier function following long-term treatment with moisturizers, a randomized controlled trial

BACKGROUND: Moisturizers are commonly used by patients with dry skin conditions as well as people with healthy skin. Previous studies on short-term treatment have shown that moisturizers can weaken or strengthen skin barrier function and also influence skin barrier recovery. However, knowledge of the effects on skin barrier function of long-term treatment with moisturizers is still scarce. OBJECTIVES: To investigate the impact of long-term treatment with moisturizers on the barrier function of normal skin, as measured by transepidermal water loss (TEWL) and susceptibility to an irritant, and to relate those effects to the composition of the designed experimental moisturizers. METHODS: Volunteers (n = 78) were randomized into five groups. Each group treated one volar forearm for 7 weeks with one of the following preparations: (i) one of three simplified creams, containing only a few ingredients in order to minimize the complexity of the system; (ii) a lipid-free gel; (iii) one ordinary cream, containing 5% urea, which has previously been shown to decrease TEWL. The lipids in the simplified creams were either hydrocarbons or vegetable triglyceride oil, and one of them also contained 5% urea. After 7 weeks, treated and control forearms were exposed for 24 h to sodium lauryl sulfate (SLS) using a patch test. TEWL, blood flow and skin capacitance of both SLS-exposed and undamaged skin were evaluated 24 h after removal of patches. Additionally, a 24-h irritancy patch test of all test preparations was performed on 11 volunteers in order to check their possible acute irritancy potential. RESULTS: Changes were found in the barrier function of normal skin after 7 weeks of treatment with the test preparations. The simplified creams and the lipid-free gel increased TEWL and skin response to SLS, while the ordinary cream had the opposite effect. One of the simplified creams also decreased skin capacitance. All test preparations were shown to be nonirritant, both by short-term irritancy patch test and by measurement of blood flow after long-term treatment. CONCLUSIONS: Moisturizers influence the skin barrier function of normal skin, as measured by TEWL and susceptibility to SLS. Moreover, the effect on skin barrier function is determined by the composition of the moisturizer. The ingredients which influence the skin barrier function need to be identified, and the mechanism clarified at the molecular level.     

A double‐blind,randomized study to assess the effectiveness of different moisturizers in preventing dermatitis induced by hand washing to simulate healthcare use

Background Healthcare‐associated infection is an important worldwide problem that could be reduced by better hand hygiene practice. However, irritant contact dermatitis of the hands as a result of repeated hand washing is a potential complication that may be preventable by the regular use of an emollient. Objectives To assess the effect of moisturizer application after repeated hand washing (15 times daily) vs. soap alone. Methods In a double‐blind, randomized study, the effect of five different moisturizers on skin barrier function was determined by assessment after repeated hand washing over a 2‐week period in healthy adult volunteers. Assessments of transepidermal water loss (TEWL), epidermal hydration and a visual assessment using the Hand Eczema Severity Index (HECSI) were made at days 0, 7 and 14. Results In total, 132 patients were enrolled into the study. A statistically significant worsening of the clinical condition of the skin as measured by HECSI was seen from baseline to day 14 (P = 0·003) in those subjects repeatedly washing their hands with soap without subsequent application of moisturizer. No change was seen in the groups using moisturizer. Subclinical assessment of epidermal hydration as a measure of skin barrier function showed significant increases from baseline to day 14 after the use of three of the five moisturizing products (P = 0·041, 0·001 and 0·009). Three of the five moisturizers tested led to a statistically significant decrease in TEWL at day 7 of repeated hand washing. This effect was sustained for one moisturizing product at day 14 of hand washing (P = 0·044). Conclusions These results support the view that the regular application of moisturizers to normal skin offers a protective effect against repeated exposure to irritants, with no evidence of a reduction in barrier efficiency allowing the easier permeation of irritant substances into the skin as has been suggested by other studies. Regular use of emollient in the healthcare environment may prevent the development of dermatitis.