A bioengineering study on the efficacy of a skin protectant lotion in preventing SLS-induced dermatitis

Background/aims: This study evaluated the efficacy of a dimethicone skin protectant lotion against sodium lauryl sulfate (SLS)-induced irritant contact dermatitis (ICD) by clinical visual grading and bioengineering techniques in 12 healthy humans.
Methods: The flexor aspects of both forearms of the subjects were used as test sites. Each test was duplicated to diminish the variations of the test sites. In a random order and a double-blind manner, two test sites were pretreated either with the testing protectant lotion or with its vehicle control prior to contact with SLS. Thirty minutes later, 0.2 ml of 0.5% SLS in a polypropylene chamber was applied to each pretreated site. One additional test site served as a positive control (without lotion), receiving the irritant only. After 24 h of exposure to the irritant, the chambers were removed. The efficacy of protective effect was determined by four parameters: visual scoring (VS), transepidermal water loss (TEWL), skin color ( a * value), and cutaneous blood flow volume (BFV). All test sites were assessed with the parameters daily for 5 days.
Results: The VS data showed a significant decrease on the site pretreated with protectant lotion in comparison with the SLS-only treated site ( P <0.01) and with the site pretreated with control vehicle ( P <0.05) (overall for 5 days). TEWL value was significantly decreased in comparison with the SLS-only treated site ( P =0.02 at day 2; P =0.008 at day 4; P =0.014 at day 5) and with the site pretreated with the control vehicle ( P <0.05) (day 2, 4 and 5). However, the BFV and a * values did not show a statistical difference between protectant lotion, vehicle, and SLS-only treated sites.
Conclusions: This study demonstrated that appropriate dimethicone skin protection products may provide certain benefits from surfactant ICD. The skin protectant lotion may be used to prevent ICD in home or work environments, where skin irritants may induce dermatitis or eczema.     

Use of digital photography and image analysis techniques to quantify erythema in health care workers

Background/aims: Nosocomial infections affect up to 26% of ICU patients. Compliance with the required hand hygiene procedures remains low, rarely exceeding 50%, with skin irritation as one of the main reasons for lack of conformity. The aim was to quantify the epidermal barrier effects, particularly erythema, from repetitive exposure to hand hygiene procedures among health care workers (HCWs) using an objective, reliable clinical method that could evaluate the entire hand surface. Methods: The hand skin of HCWs was evaluated before the initial scrub and at the end of multiple 2–3 days work cycles during spring (n=54) and winter (n=60) trials. The skin condition was measured with live visual skin evaluation (LSG), digital image analysis (DIA) of high‐resolution digital images, and visual perception evaluation (VPS) of image pairs. Results: The HCWs had significantly higher values of erythema than the non‐HCW control group with all methods. Knuckle erythema increased over the cycle in both seasons. It decreased during recovery in spring and continued to increase during recovery in winter. For the DIA area of excess redness, the quantitative measure of erythema, the decrease over the cycle in spring was significantly different than the increase over the cycle in winter. Minimal changes in area of excess redness occurred during recovery in both seasons. With the VPS, both judges found a decrease in erythema during recovery in spring and an increase during recovery in winter, indicating significant differences for spring vs. winter (P<0.05). No differences in VPS erythema were seen for either product set over the work cycle during spring. Correlations were observed for (1) results for the VPS vs. the LSG method and (2) between excess erythema (μ+σ) from DIA and the VPS erythema scores. Relatively low correlations were found between the DIA and VPS methods, i.e., knuckle μ+σ and VPS erythema. Conclusions: Significant work cycle effects for spring vs. winter were observed with DIA, while significant effects were found during the recovery period with VPS. DIA produced an objective quantitative measure of erythema that was not limited or influenced by other aspects of skin irritation (e.g., dryness, scaling) or texture encountered in the visual methods of LSG and VPS. The DIA method minimizes the difficulty in differentiating erythema severity. Standardization of image capture and processing allows assessment of skin condition across clinical locations. The VPS is a more reliable way to compare skin condition at different times, i.e. beginning vs. the end of a treatment cycle, because images are viewed simultaneously and can be carefully examined for differences.     

Visual attention to variation in female facial skin color distribution

Objectives  Visible skin condition of women is argued to influence human physical attraction. Recent research has shown that people are sensitive to variation in skin color distribution, and such variation affects visual perception of female facial attractiveness, healthiness, and age.
Methods  The eye gaze of 39 males and females, aged 13 to 45 years, was tracked while they viewed images of shape- and topography-standardized stimulus faces that varied only in terms of skin color distribution.
Results  The number of fixations and dwell time were significantly higher when viewing stimulus faces with the homogeneous skin color distribution of young people, compared with those of more elderly people. In accordance with recent research, facial stimuli with even skin tones were also judged to be younger and received higher attractiveness ratings. Finally, visual attention measures were negatively correlated with perceived age, but positively associated with attractiveness judgments.
Conclusions  Variation in visible skin color distribution (independent of facial form and skin surface topography) is able to selectively attract people's attention toward female faces, and this higher attention results in more positive statements about a woman's face.     

Interaction of skin color distribution and skin surface topography cues in the perception of female facial age and health

Background Skin color distribution and skin surface topography are the predominant drivers of the variation in visible skin condition, and this variation affects one’s perception of age and health. Recent research, however, has shown that the strength of the impact of these features on perception differs such that skin surface topography is a stronger indicator of age, while skin color distribution is more strongly linked to health perception. Objectives To examine further the relative contribution and interaction effects of skin color distribution and surface topography cues on perception by considering small changes of these features. Methods Two sets of images were created by gradually smoothing uneven skin color distribution and removing skin surface topography cues (both in 25% increments) in the digital image of the face of a 61‐year‐old British woman. Omnibus pairwise combinations of modified images were presented to a panel of 160 German men and women (aged 19–49 years). With each pair, they were asked to select the face they considered both younger‐looking and healthier. Results Female facial age perception was more strongly affected by the removal of skin surface topography cues than by changes in skin color distribution, particularly so for topography removal of 50% and more. In contrast, the smoothing of uneven skin color distribution had a stronger effect on the perception of female facial health, particularly for changes of 25% and greater. Conclusions These results support previous reports on the differential effects of visible skin color distribution and surface topography cues on the perception of female facial age and health and show that only relatively small changes are necessary to drive this differential perception.     

Efficacy of topical corticosteroids on irritant skin reactions

Topical corticosteroids are frequently used in the treatment of irritant contact dermatitis (ICD). The efficacy of this treatment has, however, not been thoroughly established, and experimental studies on the topic have provided conflicting results. The aim of the present study was to evaluate the effect of potent topical corticosteroids on experimentally-induced irritant skin reactions in a double-blind, vehicle-controlled study. 16 healthy volunteers had sodium lauryl sulfate patch tests symmetrically applied to the upper arms. After removal of patch tests, a potent topical cortico-steroid (betamethasone-17-valerate) was applied to the irritant skin reaction on one arm, while the corresponding vehicle was applied to the irritant skin reaction on the opposite arm 2 × daily for 7 days. Reactions were evaluated by measurement of transepidermal water loss (TEWL) and erythema. After 7 days, statistically significant lower values of TEWL and erythema were found in corticosteroid-treated, compared to the vehicle-treated, skin reactions. The results indicate that topical corticosteroids improve healing of ICD.     

皮肤颜色客观评估方法的比较

目的:通过比较皮肤科学和化妆品研究领域常用的两种皮肤颜色仪器测量方法,为临床和科研提供实际应用指导。方法:应用三刺激值色度计(MinoltaChromameterCR200)和窄谱反射分光光度计(MexameterMX16及MX18)先定量测定标准色板和志愿者皮肤颜色,然后再比较这些仪器在体内外测定的重复性、敏感性以及相关性。结果:这3种仪器在体内外都表现出重复性高(CV=0.01%～3.32%)、敏感性好。MexameterMX16及MX18在体外及人体都有显著相关性(P<0.01)。两种型号的Mexameter与ChromameterCR200间也显著相关(P<0.01)。结论:3种仪器都能准确地表现皮肤颜色。L*、b*、MI适合色素沉着测定,而a*、EI则更适合测定皮肤的红斑。     

几种婴儿常见皮肤病的皮肤微生态研究进展

近年来报道婴儿期皮肤病可能与局部皮肤微生态失调关系较密切,本文综述了婴儿期特应性皮炎、新生儿痤疮、脂溢性皮炎、新生儿红斑和皮肤微生态关系。     

Role of phototherapy in patients with skin of color

Phototherapy has proven to be one of the most versatile and effective treatment options for a variety of inflammatory and pigmentary skin diseases. However, the use of these treatment modalities in patients of color requires some special considerations. The modality chosen, the dosing of the treatment and duration of treatment are all issues to be considered for patients of color treated with ultraviolet phototherapy. In addition, there are some diseases which are more commonly seen in patients of color. These diseases may have better treatment outcomes using newer phototherapeutic options such as the long pulsed Nd:YAG laser or UVA1. As our population in the United States becomes more diverse it would behoove all dermatologists to acquaint themselves with the special circumstances of treating ethnic patients with phototherapy.     

Topographic measurement of skin color by narrow-band reflectance spectrophotometer and minimal erythema dose (MED) in Koreans

Background/aims: Narrow-band reflectance spectrophotometer is one of the objective and quantitative devices for measuring the skin colors. There has been some controversy concerning the relationship between the objectively measured skin color and cutaneous responsiveness to ultraviolet radiation, including minimal erythema dose (MED). The aims of this study were to compare the color of Korean brown skin with that of Caucasians by objective measurement with the narrow-band reflectance spectrophotometer, and to determine whether the skin color has any correlation with MED in Koreans, and demonstrate differences in this correlation according to the anatomical sites. Methods: With narrow-band reflectance spectrometer, skin colors were measured at 17 body sites of 20 healthy Korean male volunteers after measuring MED for the same subjects. Results: The constitutional skin color, as measured by the melanin index of the nonexposed sites, showed a statistically significant correlation with MED values, whereas the facultative skin color did not. The Korean brown skin showed higher melanin index and lower erythema index compared with that of Caucasians. Conclusions: We confirmed significant differences in the correlation between MED and melanin indices, depending on the anatomic sites. This suggests that selection from various sites, even among the nonexposed sites, is quite important and deserves further evaluation.     

Quantifying facial skin erythema more precisely by analyzing color channels of The VISIA Red images

Background: The VISIA Red images were developed to document and measure facial skin erythema, but diffuse erythema cannot be fully segmented by the VISIA system due to the automatic thresholding segmentation method. Moreover, topical area analysis is not available in the system. Materials and methods: Erythema severity degrees of 20 simulated Red images were designated 1–20 with 1–20 inflammatory lesions for each, respectively. The RGB channel mean values of each simulated image were acquired by ImageJ and relative intensity of red values calculated. Results: The relative intensity of red values positively correlate to erythema severity with a coefficient of 0.999345 (p < 0.001). We also proposed a method for calibration when pustules were present in the erythema area. The method was proved by mathematical reasoning and verified by certified dermatologists. Conclusion: We demonstrated a simple and more precise method to quantify and compare facial skin erythema by analyzing the RGB channel values of the VISIA Red images. Our method brings convenience for erythema evaluation in dermatological studies.     

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.     

A study of matrix metalloproteinase expression and activity in atopic dermatitis using a novel skin wash sampling assay for functional biomarker analysis

Background Atopic dermatitis (AD) is a chronic inflammatory skin condition that is characterized by a defective skin barrier. Despite the well‐recognized role of proteases in skin barrier maintenance, relatively little is known of the contribution made by matrix metalloproteinases (MMPs) to the inflammatory process in AD. Objectives To test a simple, novel ex vivo bioassay technique in an analysis of the MMPs present in wash samples taken from the skin surface of patients with AD. Methods Saline wash samples were collected from eczematous and unaffected areas of the skin of patients with AD and from the skin of normal controls. Wash samples were analysed for their MMP content using a functional peptide cleavage assay, gelatin zymography and an antibody array. Results Using a functional substrate cleavage assay, skin wash samples from AD lesions were shown to contain 10‐ to 24‐fold more MMP activity than those from normal control skin (P < 0·02) and fivefold more than those from unaffected AD skin (P < 0·05); this activity was inhibited by a broad‐spectrum MMP inhibitor Ro 31‐9790. Gelatin zymography and antibody array analysis revealed substantial levels of MMP‐8 (neutrophil collagenase) and MMP‐9 (92‐kDa gelatinase) in AD skin wash samples as well as lower levels of MMP‐10 (stromelysin 2) and tissue inhibitor of metalloproteinases (TIMP)‐1 and TIMP‐2; low levels of MMP‐1 (fibroblast collagenase), MMP‐3 (stromelysin 1) and TIMP‐4 were also detected. Conclusions A simple skin wash technique suitable for the quantitative and functional analysis of biomolecules in AD is described. Using this method we show that MMPs, and in particular MMP‐8 and MMP‐9, represent an important potential component of the pathology of AD. The method is expected to prove useful in advancing our understanding of AD and in identifying biomarkers for the evaluation of new therapies.     

A slime of the times: Two cases of acute irritant contact dermatitis from homemade slime

We describe two cases of acute‐onset erythema, peeling, and pruritus or tenderness isolated to the palmar surface of the hands. A detailed exposure history revealed significant periods of contact with homemade slime; given the clinical findings and timing of exposure, acute contact dermatitis of the hands was suspected. Symptoms and clinical findings resolved after avoidance of the suspected causative contactants. There are few if any reported cases of contact dermatitis to homemade slime in the literature; this serves to highlight the importance of a thorough exposure history in the evaluation of hand dermatitis.