Barrier Cream for Dermatitis

Dermatitis barrier cream

Efficacy of barrier creams against irritant contact dermatitis. A barrier cream for use in chronic hand dermatitis. Skin dermatitis (irritant, allergic or both) is the most common occupational skin disease. The barrier cream with Lipogrid technology (Ceramax) proved effective in reducing or eliminating chronic hand contact dermatitis caused by occupational exposure. Though plasticizers and topical steroids are an important part of the treatment, irritant contact dermatitis is avoidable.

Efficacy of barrier creams against irritating contact dermatitis - Full text - Dermatologie 2016, Volume 232, No. 3

Dermatological tissues in the work place, especially during work in the water, are often subjected to various irritating agents which can cause the emergence of professional dermatitis. Barrier cream (BC) is well known and its use is still the object of many research es and controversy. From 1956 to December 2014, MEDLINE, PubMed, references and current review papers covered all BC control study data for human dermal stimulants.

Thirty nine clinical trial results on the effect of a BC on human irritation were chosen. Of these, 27 were found to be study subjects in health with many different levels of B.C. and irritant substances used, their amounts, test sites, techniques and evaluation methodologies. While this report emphasizes the low level of workmanship and absence of standardisation in most clinical trial results, it appears that B.C.'s have a protecting effect against the irritant.

Vocational dermatitis (OCD) accounts for 90% of all work-related dermatitis, of which the total incident rate is 9.1-31 per year. Urgent or chronical exposition to stimulants can result in inflammatory dermatitis, which accounts for 80% of all OCDs[3]. Excessive eczema is due to a non-immunological response that can occur immediately or cumulatively over a period of years.

Injured, dehydrated and coarse epidermis enhances the permeation of substance in the stratum corneum and serves as a reserve for the penetrating substances[6]. There are two kinds of product for protecting hands among our range of dermal creams: barrier protective cream or barrier cream (BCs) and barrier cream repair[7].

They are used to avoid the irritation effect of professional exposures and are suggested for use before and during work. A few writers call them pre-work creams[8,9,10]. It has also been referred to as "invisible gloves", but the expression "skin protection creams" is more appropriate[10]. It is the aim of the BCs either to retard or to retard the cutting edge permeation of any substance which, at the moment of dermal contacts, may have adverse actions or may cause systematic actions by means of subcutaneous absorption[11].

Therefore, they are used to decrease the irritation effect of compounds and to prevent irritating dermatitis. Rejuvenating barrier lotions, also known as regenerating lotions, care lotions, softeners or moisturizers[10], are supposed to improve moisturization through the hydroscopic effect of wetting agents such as amino acides, carbamide, glycerine, milk dioxide (LA) or pyrrolidonecarboxylic acid[12] and re-establish the skin's own barrier.

In spite of controversy, the Cochrane database[14] showed that in some professions, such as metalworking, printmaking and dyeing, B.C.'s and humectants can have a protecting effect, but without the statistically significant effect obtained from their 4 chosen clinical trial projects. In order to broaden the scope to include focused clinical investigations of skin irritant agents in the BC, we have conducted a rigorous screening to see if additional efficacy information can be found.

In 39 studies (Table 1), the effect of B.C. against irritation was investigated in a group of 929 individuals (172 men, 279 females and 481 non-specified individuals) with normal cutaneous health (n = 28), Handdermatitis (n = 1), sensitised to a certain type of hypoallergen (n = 4) and 1 trial on rubber gloves allergens[6,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52].

Of these 39 documents, excess skins studies[18,24,40,41,43,46] were rejected and only those with normal and insensitive skins were maintained, which reduced the shortlist to 27 documents in Figure 1. Unprocessed skins were used for monitoring in each study. Hautlokalisationen with the test persons were the lower arms (n = 15), back (n = 8), hand (n = 3), lower arms and back (n = 1).

The Stokoderm® (n = 3), Taktosan (n = 3), Kerodex 71 (n = 2) and Arretil (n = 2) are the 4 most commonly tested crèmes. A number of papers refer only to the ingredients of the cream examined without using commercially any name. Most commonly used stimulants are caustic soda (SLS, hydrophil type, n = 16) and toluene compound (lipophil type, n = 9).

Potassium hydrogen oxide (NaOH, n = 7) and LA (n = 5) are other commonly used stimulants that are being used. Often the amount of irritant substances used is not stated. Contacting times of stimulants range from 5 seconds to 24 hours, but the most frequently occurring is 30 minutes (n = 11) and 24 hours (n = 4).

2 sketches showed elevated stimulant penetration[27,45] and 3 sketches showed an increase in irritation[26,32,50]. The protection provided by the 4 most frequently used CCs is shown in Figure 2. We can see in Figure 3, which reported the existence or non-existence of the effectiveness of the above mentioned DCs on the 4 most commonly used stimulants, that DCs appear to have protections against SLS, NaOH and LA, but not against toluene. However, the results of the study are not available.

Chart 1 shows that the trials chosen were not carried out under the same conditions: trial designs, cream, irritants used and evaluation method. It is also necessary to consider the following factors: dermal temperatures, pH, cream coating thicknesses, number of treatments, dryness before exposition, duration of treatment, duration of treatment, duration of treatment in direct physical contact with the stimulant, concentration and quantity of stimulants, regions of the human anatomy examined (back, palms or forearms), persons examined (sex and ethnicity), existence or non-existence of signs of occlusion and duration of the study[4,28,41,53].

Inter-individual variation is also a feature of anthropogenic skin[22]. At work, stimulants are often a mix of different compounds, but the studies chosen in this paper were conducted with isolates. Length of exposition, incidence and level of stimulant are 3 influencing factor of professional exposition.

Since OCD is often the result of chronical exposures, the method of repeated stimulus testing could replicate situations nearer to vocational exposures than single-contact trials. Wigger-Alberti et al. et al. 55 ] on the self-application of a protective cream also showed that certain areas of the hand were not adequately sheltered.

There is a very broad spectrum of cream amounts used. The Schliemann et al. [ 56] pointed out that the amounts of bc per dermal area used in experimentation could be far removed from those used under actual circumstances, which would lead to an overestimate of their effectiveness. Whereas work-related dermatological disorders affect the hand in more than 90% of cases[7], the most common areas of use in our chosen trials are the lower arms and back.

Overall, the trials did not consider the frictional motions that occurred in real -life settings or sweat, leading to an overestimate of BC efficacy[28,57]. Comment: The voluntary workers were evaluated only on the basis of age. These showed that the BC program (using body lotions and body creams) was as efficient as using BC alone, as opposed to moisturisers alone, but the best barrier was achieved by the combination of them.

Kuetting et al. [ 59] emphasize the contrasts with the results of an Austria perspective four-arm four-arm Randomised Control Study of 485 out of 1,006 construction (n = 198) and woodworking (n = 287) professionals conducted over a period of one year in which each subjects was evaluated by manual dermatitis classification, transsepidermal moisture losses and perceived subjectivity.

Neither of the 4 groups showed a protecting effect on the dermatitis. In the latter case, it is also proposed that bio-physical trials may yield information on changes in dermal conditions before obvious dermatologic changes occur[52], while other writers believe that occupational evaluation is more appropriate[36,60].

A number of contributors believe that the degree of trans epidermal moisture depletion is the best indicator of the change in the barrier, even if some compounds change this indicator only slightly[22,35,36,61,62]. A significant deficiency of standardisation exists in the chosen trials, as more than 20 designated commercially available bc's were differently assayed against several different stimulants (Table 1), so that it was not possible to combine the results.

Results were generally favourable to 3 of the 4 most commonly used stimulants (Table 3). Berndt et al. [ 63] found in their double-blind, randomised, screened study with 50 female doctors who compared a BC and its vehicles an improved complexion when using cream without significant difference between the two groups, which underlines a shortage of placebo-controlled, screened randomised trials.

Contrary to Wang et al. [ 64], some suggest that the BC should only be used for exposures to light stimulants (water, cleaning products, organics or cutters ) as they cannot neutralise a high dosage of stimulants[13,61]. In fact, the active ingredients secreted in the cream coat enter the epidermis after saturation[18,28] if the ingredients are not deactivated by BCS.

These explain the ability of some B cs to cause contagious dermatitis[4] and enhance irritant sensitivity of the skin[61]. Protecting against the effects of toluene is very limited, as shown in Figure 3, and will need to be enhanced in the near-term. It is only the initial protective action of the still intact complexion that can be optimally effective in preventing obsessive-compulsive disorder[63].

Similarity of tests to evaluate the effectiveness of DCs is hampered by the absence of standardisation, although a tendency towards a certain level of safety can be observed, although the cars appear to be equally effective. Repeated stimulus testing is a method nearer to real life and could be used to evaluate exposure to one or more stimulants.

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