A randomized comparison of an emollient containing skin-related lipids with a petrolatum-based emollient as adjunct in the treatment of chronic hand dermatitis

Hand dermatitis is a multifactorial skin disorder in which skin barrier impairment is involved in the pathogenesis. The development of topical agents that improve skin barrier function is therefore a promising approach for the management of hand dermatitis. Topically applied lipids may interfere with skin barrier function, and emollients containing skin-related lipids have been suggested to facilitate repair of the skin barrier. However, evidence for the superiority of emollients containing skin-related lipids over the more traditional emollients is still lacking. The aim of this study was to compare an emollient containing skin-related lipids (Locobase Repair) with a traditional petrolatum-based emollient for the management of hand dermatitis. Adult males and females (n = 30) with mild to moderate chronic hand dermatitis were treated twice daily for 2 months either with an emollient containing skin-related lipids or with a pet.-based emollient. In the case of exacerbation, the patients of both treatment groups were allowed to use a mild corticosteroid according to instructions. Both treatment regimes significantly improved clinical signs of hand dermatitis as assessed by the investigator global assessment, hand eczema area and severity score. We did not observe significant differences in the improvement of clinical signs, itching, patients' assessment of efficacy, cosmetic acceptability or usage of topical corticosteroids between both treatment groups. In conclusion, this study confirms that the frequent use of emollients may be useful in the therapy of hand dermatitis. However, we could not demonstrate the superiority of this particular emollient containing skin-related lipids in patients with chronic hand dermatitis.     

Severe allergy to sorbolene cream

A 40-year-old male developed a constant hand and foot dermatitis in 1980 while using sorbolene cream as a barrier cream at work. He was forced to leave his trade as a motor mechanic because of his hand dermatitis. It was not until 16 years later that he was diagnosed as having an allergic contact dermatitis to chlorocresol secondary to an endogenous hand and foot dermatitis. Chlorocresol is the preservative used in sorbolene cream as well as many corticosteroid creams. Patch testing carried out in 1983 was negative but had omitted testing with chlorocresol or sorbolene cream.     

Percutaneous absorption of 3 organic solvents in the guinea pig (III). Effect of barrier creams

The efficacy of 4 barrier preparations presented as cream or foam against percutaneous absorption of organic solvents was investigated in the guinea pig. An ordinary hand cream was also tested. Slight reduction in blood concentration of the solvents was seen when normal skin treated with barrier creams was exposed. Absorption of butanol through stripped skin treated with barrier creams was higher than absorption through skin not so treated. Barrier creams can be considered to give poor skin protection against the organic solvents investigated.     

Skin protection in bakers' apprentices

Skin protection measures - barrier creams, protective gloves - and skin care are widely recommended for the prevention of occupational hand dermatitis (HD) in skin risk professions, but there is hardly anything known about uptake levels of the measures. The objective of this controlled intervention study was to quantify the uptake and maintenance of skin protection and skin care measures in first-year bakers' apprentices. A total of 94 first-year bakers' apprentices were included in the study in September 2000. The apprentices were assigned to the skin protection and control group class-wise to reduce contamination. The skin protection group comprised 39 apprentices who were trained in skin protection measures at the beginning and after 4 weeks of training. 55 apprentices were assigned to the control group representing no skin protection intervention. Standardized interviews took place at the beginning of the training and at 4 monthly follow-ups (FU). The uptake of skin protection measures differed significantly between the groups (barrier cream p < 0.0001, protective gloves p = 0.046, skin care p = 0.025). Barrier cream use in the skin protection group was incorporated in the daily routine very well from the start and reached 100% at the end of the examination period (4th FU). At this time, only 3.2% of the controls used barrier creams. The level of acceptance of protective gloves (4th FU: skin protection group 43.3%; controls 32.3%) was considerably lower than that of barrier creams. The initial level of regular skin care was high in both groups (skin protection group 67.6%, controls 61.7%). After the intervention the acceptance of skin care rose to 88.9% in the skin protection group compared to 68.1% in the controls (4th FU). The present study has shown that skin protection and skin care measures can be introduced successfully in the daily routine of a skin risk occupation and high uptake and maintenance rates can be achieved.     

Hydrocortisone butyrate 0.1% cream in the treatment of chronic dermatitis

This multicenter, randomized, double-blind clinical trial involving 89 subjects (86 with chronic hand dermatitis and 3 with atopic dermatitis) compared the safety, efficacy, and cosmetic acceptability of 4 medium-potency topical corticosteroid products: hydrocortisone butyrate (HB) 0.1% cream (Locoid Lipocream), fluticasone propionate (FP) 0.05% cream (Cutivate), prednicarbate (PC) 0.1% cream (Dermatop), and mometasone furoate (MF) 0.1% cream (Elocon). Subjects were randomly assigned to 1 of 3 treatment groups (HB vs FP, HB vs PC, or HB vs MF) and further randomized to HB on the right or the left side, and FP, PC, or MF on the contralateral side. Treatments were self-administered twice daily for 2 weeks. Assessments of efficacy were based on the investigator ratings of signs and the subject ratings of signs and symptoms. Cosmetic acceptability was assessed by direct comparisons between products using a subject questionnaire. The results indicated comparable efficacy of all 4 medium-potency corticosteroid products and suggested that, compared to other corticosteroid creams, the HB vehicle yielded somewhat greater subject preference with respect to cosmetic appeal.     

Efficacy of bufexamac (NFN) cream in skin diseases. A double-blind multicentre trial.

The effect of a new non-steroid anti-inflammatory substance (bufexamac) in a special constituent was compared with that of 0.1% triamcinolone acetonide, 1% hydrocortisone cream, and placebo during a double-blind multicentre trial. The clinical effect of these four creams was studied in 193 patients receiving treatment for the following skin disorders: atopic dermatitis, allergic contact dermatitis, and non-allergic contact dermatitis, as well as dermatitis seborrheica. After 2 and 4 weeks' treatment, when 193 and 157 patients, respectively, were re-examined, the effect of triamcinolone acetonide and hydrocortisone cream was significantly better, than that obtained with bufexamac in the cream basis employed. On the other hand, no statistically significant difference in effect between bufexamac and placebo cream was observed.     

S1 guideline on occupational skin products: protective creams,skin cleansers,skin care products (ICD 10: L23, L24) – short version

Job‐related hand dermatitis heads up the list of reported occupational diseases. So‐called skin products – understood to mean protective creams, skin cleansers and skin care products – are used for the primary and secondary prevention of job‐ related hand dermatitis. In the interests of evidence‐based medicine, the only preventive measures and/or occupational skin products that should be used are those whose potential uses and efficacy are underpinned by scientific research. To this end, the Arbeitsgemeinschaft für Berufs‐ und Umweltdermatologie e.V. (Working Group for Occupational and Environmental Dermatology, ABD) of the DDG (German Dermatological Society) and the Deutsche Gesellschaft für Arbeits‐ und Umweltmedizin (German Society for Occupational and Environmental Medicine, DGAUM) have summed up the latest scientific findings and recommendations in the updated guideline. The benefit of the combined application of protective creams and skin care products in the primary and secondary prevention of work‐related contact dermatitis has been widely confirmed by recent clinical‐epidemiological studies. The guideline clearly explains the necessity of demonstrating the efficacy of protective creams and cleansing products by means of in vivo methods in the sense of repetitive applications. Transferable standardised testing systems designed to examine the irritation potential and thus the compatibility of occupational skin cleansers and the reduction of irritation by protective skin creams have now been developed and validated by multicentre studies for skin protection creams and cleansers. The status of the current assessment of the safety of occupational skin products is also summarised.     

A Skin Moisturizing Cream Containing Quaternium-18-Bentonite Effectively Improves Chronic Hand Dermatitis

BACKGROUND: Irritant and allergic hand dermatitis is difficult to control in individuals who are unable to avoid causative exposures. Effectiveness of "protective" creams has been poor. OBJECTIVE: To determine if hand dermatitis, primarily of an occupational nature, could be improved by the use of a newly developed moisturizing cream containing Quaternium-18-Bentonite. METHODS: Adult male and female subjects with chronic hand dermatitis felt to be either allergic, irritant, or combined in nature, after a 2-week observation period, were given the study cream for routine application. At 2, 4, and 8 weeks, the investigator and the subject evaluated the skin parameters, including redness, scaling, fissuring, blistering, and pruritus, on a numerical scale. A global evaluation was also performed. Photographs were taken at each visit. Use of topical corticosteroids was recorded. No systemic therapies other than antihistamines were allowed. RESULTS: Thirty-seven subjects were enrolled in the study and 33 completed it. The physician's and the subject's initial global evaluations averaged 6.0 and 5.8, respectively (0-10 scale). The final scores were 2.9 and 2.8, respectively, an improvement of 50% (p < 0.001). Topical corticosteroid usage was reduced in 29 of 33 subjects. Fifteen of 35 had a final score of 0-2, indicating complete or almost complete clearing. Only 10, including 2 of the dropouts, failed to show improvement. No adverse effects were noted. COMMENT: This moisturizing cream significantly improved chronic hand dermatitis in a majority of individuals with previously uncontrolled dermatitis despite continuing in their regular occupation.     

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.     

Water protective effect of barrier creams and moisturizing creams: a new in vivo test method

Frequent exposure to water is an important risk factor for the development of irritant hand eczema. Evaluation of cream efficacy in protecting against water is difficult. A new non-irritant, non-invasive method is introduced, based on evaluation of colour intensities when an aqueous solution of crystal violet is applied to the skin, after pretreatment with different creams. By skin reflectance measurement, differences in colour intensity were objectified. Measurements of transepidermal water loss were also performed. 2 barrier creams and a moisturizer were tested on the dorsal and volar aspects of the handy One barrier cream contained silicone the other solid particles. The moisturizer had a high content of lipid. In one experiment, the immediate effect of the cream in protecting against water was evaluated. In a second experiment, the water resistancy of the creams was tested, using a standard water immersion procedure (4X20 min). The barrier cream with particles gave the best immediate protection (dorsal 76% volar 69%). The moisturizer was intermediately protective (dorsal 57% volar 34%) while very link protection was found for the silicone-containing cream (dorsal 16% volar 10%). The water immersion procedure resulted in only minor changes in protection for each cream. When comparing transepidermal water loss in the treated areas with pretreatment values, a reduction was recorded only for the particle-containing barrier cream. The colour method described may be used as a quick and easy test of the protective effect of creams against water.     

Methods for the evaluation of barrier creams

Barrier creams are used extensively in industry to protect the hands from chemical injury. They are also prescribed to protect the skin when inflamed from further damage in such conditions as hand eczema and napkin dermatitis. Despite their wide usage very little is known concerning their efficacy as there are no established methods for their assessment. In this study we describe a new technique for the evaluation of barrier creams and assess an adaptation of another recently described method.
In the new technique the ability of barrier creams to prevent a variety of dyes in different solvents from contacting the skin has been assessed. The excluding properties of the barrier creams was measured by taking skin surface biopsies and measuring the amount of dye reaching the skin spectrophotometrically as a function of time from exposure. The other method assesses the ability of weak alkalis to cross the barrier cream by measuring the time taken to induce increased blood flow (measured by the laser Doppler flow meter) after application of the test materials.
Both tests succeeded in demonstrating that barrier creams inhibit the penetration of the test substances. However, the barrier properties were time-dependent as well as varying with the particular preparation used. For example, using 0·1 % methyl violet in water as a test substance it was found that a 'water barrier' preparation inhibited penetration to skin up to 90% of control values at 15 min, but only 75% at i hour, whereas the figures for a solvent barrier were 72% and 55%- We believe that such assessments are vital in order both to understand the properties of barrier creams and recommend their correct usage.     

Instrumental and dermatologist evaluation of the effect of glycerine and urea on dry skin in atopic dermatitis

Background/aims: Moisturising creams are useful treatment adjuncts in inflammatory dermatoses and have beneficial effects in the treatment of dry, scaly skin. The effects on dryness and skin permeability of a new moisturising cream with 20% glycerine was compared with its placebo and with a medicinally authorised cream with 4% urea (combined with 4% sodium chloride) in the treatment of dry skin.
Methods: Patients ( n =109) with atopic dermatitis were treated for 30 days with a moisturiser in a randomised, parallel and double-blind fashion. Transepidermal water loss (TEWL) and skin capacitance were assessed instrumentally, and changes in the dryness of the skin were assessed by the dermatologist.
Results: No difference in TEWL was found between glycerine treatment and its placebo, whereas a lower value was found in the urea-treated area compared to the glycerine-treated area. No difference in skin capacitance was found. The clinical assessment of dryness showed urea to be superior to glycerine in treating the condition.
Conclusions: Moisturising creams are different, not only with respect to composition but also with respect to their influence on skin as a barrier to water in patients with atopic dermatitis.     

Bioengineering measurements of barrier creams efficacy against toluene and NaOH in an in vivo single irritation test

Background/aims: By now, only a few models have been published with the goal of testing barrier creams in vivo in humans. The aim of this study was to evaluate with a single irritation test, barriers creams in humans against a lipophilic and a hydrophilic irritant, toluene and NaOH, respectively.
Methods: Both irritants were applied for 15 min after pretreatment of the skin with barrier creams. Non-invasive bioengineering methods, such as skin colorimetry (a*) and cutaneous blood flow (CBF) measurements were used to assess product protection.
Results: After toluene application on control sites, the irritation appeared quickly (T_max=3 min after patch removal), was significant (+5-6 units for a* and+80% for CBF) and did not return to base value within 1 h. Skin irritation after NaOH application, as measured by a*, was less important (+2 units) and occurred later ( T "max=40 min after patch removal). For this irritant, CBF response was minor and variable. When testing barrier properties of the products, none of them were able to prevent the skin erythema induced by toluene. Against NaOH, one barrier cream as well as petrolatum and a fatty cream protected the skin significantly.
Conclusion: The present study points out the unsatisfactory effectiveness of several commercially available barrier creams claimed to protect against lipophilic or hydrophilic irritants.     

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.     

皮肤屏障修复乳治疗激素依赖性皮炎疗效观察

目的 了解雅莎尔皮肤屏障修复乳对面部激素依赖性皮炎皮肤屏障功能改善情况及临床疗效.方法 58例面部激素依赖性皮炎患者随机分成2组,分别采用雅莎尔皮肤屏障修复乳和丁苯羟酸软膏外用,比较治疗前及治疗28 d后患者皮肤屏障功能（表皮含水量、油脂含量、经表皮水分丢失量）及临床症状体征改善情况.结果 雅莎尔皮肤屏障修复乳治疗组患者治疗前后皮肤屏障功能明显改善（P＜0.05）;临床症状体征改善优于丁苯羟酸软膏组,差异有统计学意义（P＜0.01）;有效率优于对照组（P＜0.01）.结论 雅莎尔皮肤屏障修复乳能显著改善皮肤屏障功能,对治疗激素依赖性皮炎具有良好的效果,且更易为患者所接受。     

In-situ evaluation of barrier-cream performance on human skin using laser-induced breakdown spectroscopy

Laser-induced breakdown spectroscopy (LIBS) was used to evaluate the effect of barrier creams (skin protective creams) on human skin. A Nd: YAG laser at 1,064 nm was used with a pulse energy of 100 mJ. A method was developed to measure the effectiveness of barrier creams against zinc ion absorption from aqueous zinc chloride solution and oil paste zinc oxide, which represent model hydrophilic and lipophilic metal compounds, respectively. Zinc was chosen since it posed no risk to human skin. 3 representative commercial barrier creams advertised as being effective against lipophilic and hydrophilic substances were evaluated by measuring zinc absorbed through the stratum corneum. 4 consecutive skin surface biopsies (SSB) were taken from biceps of the forearms of 6 volunteers at time periods of 0.5 h and 3 h after application of the protective cream. Results were compared with control skin where no barrier cream was used. The zinc atomic emission line at 213.9 nm was selected. Gate delay and gate width time was optimized to obtain the best signal-to-noise ratio (SNR) and precision. This method provided a facile and rapid screening of the effectiveness of skin barrier creams against zinc ion penetration. The barrier creams were shown to provide appreciable protection against the penetration of both ZnCl2 and ZnO into the skin.     

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.     

Cutting oil dermatitis on guinea pig skin

We assessed the effect of repeated application of cutting oil on 9 guinea pigs' skin by visual scoring and skin water vapour loss measurement. The visual scores (severity score) were significantly higher on skin treated with cutting oil (positive control) compared to untreated skin (negative control). The corresponding mean SVL values were also significantly higher. We also assessed the effect of 2 barrier creams on the 9 guinea pigs' skin treated with cutting oil. The visual scores on skin treated with either barrier cream were significantly higher than positive control skin. The corresponding mean SVL values on skin treated with either barrier cream were also higher (not statistically significant). It appeared that the 2 barrier creams did not confer protection against the irritant effect of the cutting oil. On the contrary, barrier creams appeared to exacerbate the irritant effect of cutting oil.     

Current acceptance and implementation of preventive strategies for occupational hand eczema in 1355 metalworkers in Germany

Summary Background  The effectiveness of a skin care programme is based mainly on the effectiveness of the products used and the frequency and diligence of the application of skin care products. Objectives  The present cross‐sectional study was aimed at evaluating the implementation and acceptance of generally recommended skin protective means at the workplace. Methods  We included in our study 1355 metalworkers, employed in 19 factories, mainly of small or medium‐size. The majority of participants were male (96·7%, n = 1310). The investigation included a standardized interview and a dermatological examination of the hands. Results  More than half of all participants (52·4%) had suffered from skin problems of the hands at some time. Three hundred and ninety‐six subjects (29%) indicated they followed the skin protection regimen as it was generally recommended, i.e. the use of barrier creams in combination with moisturizers. A similar number of participants (28%) denied any use of protective creams. In general, compliance in men was significantly poorer than in women. Participants with past or present history of hand eczema used both barrier creams and moisturizers significantly more often. The skin condition of the hands, examined using a quantitative score, did not differ significantly in the four subgroups defined by different skin protection measures. While acceptance of protective measures was limited, these were available in all factories. Conclusions  Although barrier creams and moisturizers are highly recommended as effective means to prevent irritant contact dermatitis in Germany, our data prove that the compliance of application in this group at special risk for hand eczema is extremely low.