Managing Occupational Irritant Contact Dermatitis Using a Two-Step Skincare Regimen Designed to Prevent Skin Damage and Support Skin Recovery
December 2016 | Volume 15 | Issue 12 | Original Article | 1504 | Copyright © December 2016
Erika C. von Grote PhD, Kiruthi Palaniswamy PharmD, and Matthew H. Meckfessel PhD
Galderma Laboratories, L.P., Fort Worth,TX
Occupational irritant contact dermatitis (ICD) affecting the hands is a common and difficult-to-manage condition. Occupations that necessitate contact with harsh chemicals, use of alcohol-based disinfectants, and frequent hand washing elevate the risk of ICD. Management strategies that do not adequately prevent accumulated damage and repair skin, can develop into chronic dermatoses which negatively impact work productivity and quality of life. A 2-step skin-care regimen (Excipial Daily Protection Hand Cream (EP) and Excipial Rapid Repair Hand Cream (ER), Galderma Laboratories, L.P.) has been developed as a daily-use management strategy to protect and repair vulnerable hands. The protective barrier cream is formulated with aluminum chlorohydrate and designed for pre-exposure application to enhance the skin’s natural protective barrier and minimize excessive moisture while wearing protective gloves. The repair cream, a lipid-rich formulation, is intended for post-exposure application to rehydrate and facilitate the skin’s natural healing process. The results of 3 clinical studies highlighted in this review demonstrate how the use of a 2-step skin-care regimen offers a greater protective effect against ICD than the use of barrier cream alone, and also how the formulation of the barrier cream used in these studies helps minimize the occlusion effect caused by gloves and does not interfere with the antibacterial efficacy of an alcohol-based hand sanitizer. This 2-step skin-care regimen is effectively designed to manage and minimize the risk of ICD development in a variety of patients and provides clinicians an additional tool for helping patients manage ICD.J Drugs Dermatol. 2016;15(12):1504-1510.
Occupational irritant contact dermatitis (ICD) is an in- ammatory skin reaction induced by repeated contact with chemical or physical irritants in the workplace, most frequently affecting the hands.1 Symptoms typically begin in the nger web and knuckle area of the hands and can involve the ngers, palms, back of the hands, and wrists.2 The clinical signs range from erythema, edema, and vesiculation in acute forms, to hyperkeratosis, scaling, and ssuring in more chronic forms.3 The epidermal barrier damage associated with ICD is not only uncomfortable, it increases the permeability of the skin, thus promoting further uptake of irritants and chemi- cals, perpetuating epidermal damage and irritation.4-6 An estimated 13.2 million workers in the United States are exposed to chemicals that carry Occupational Safety and Health Administration (OSHA) skin notations.7 The reported incidence of occupational ICD is between 11 and 86 cases per 100,000 workers per year, and the direct and indirect economic loss associated with employee medical treatment and loss in productivity is in excess of $1 billion annually in the United States.8,9 Individuals most at risk are those involved in wet- work occupations such as hairdressing, health care, and food service, which involve prolonged exposure to water, aqueous solutions, or detergents is often unavoidable.7,10,11 Occupational ICD accounts for as much as 90-95% of all reported cases of occupational skin disease, it is internationally ranked as the second largest category of occupational disease, which is second only to musculoskeletal disorders.12-14 The primary strategies in effect to minimize exposure to irritant in the workplace are preventative in nature and consist of educating workers of high-risk situations, and providing a means of contact avoidance by wearing gloves.6,15 Despite avoidance measures, unavoidable task-related factors may ne- cessitate the use of bare hands. Frequent handwashing and the use of alcohol-based hand sanitizers can also cause dermal irritation, and may contribute to non-compliance with hand hygiene guidelines.16-18 The protection afforded by gloves is also not without risk, as the moisture produced by prolonged glove wearing is trapped on the skin’s surface (occlusion effect) and heightens the chance of skin permeability to subsequent chemical exposures.7,15,19 Another essential strategy in preventing ICD is maintain- ing the integrity of the skin’s natural epidermal barrier, and this is achieved through the use of protective barrier creams and emollients.20,21 The use of a barrier cream to prevent ICD provides effective protection against external irritants when