Efficacy of a Hand Regimen in Skin Barrier Protection in Individuals With Occupational Irritant Contact Dermatitis
November 2016 | Volume 15 | Issue 11 | Supplement Individual Articles | 81 | Copyright © November 2016
Laura Jordan DO MS
Tri-County Dermatology, Cuyahoga Falls, OH
BACKGROUND: Occupational irritant contact dermatitis (OICD) is a dif cult and hard to manage condition. It occurs more frequently in certain occupations where contact with harsh chemicals, use of alcohol-based disinfectants, and frequent hand washing heightens the risk. Treatment for OICD includes patient education in addition to physical, topical, and systemic therapies. OBJECTIVE: To review the pathogenesis and treatment options for OICD and evaluate the ef cacy of a selective skin-care regimen involv- ing a hand protectant cream alone as well as combined with a repair cream and speci c cleanser. MATERIALS AND METHODS: A single-center open study was performed comprising 42 healthy male and female adult volunteers prone to occupational irritant contact dermatitis due to frequent wet work or contact with detergents. Between day 0 and day 7, subjects applied a hand protectant cream as needed on both hands (at least twice daily). On days 7 to 14, subjects applied a hand protectant cream and cleanser as needed on both hands (at least twice daily) as well as a repair cream each evening. A diary log was given to each volunteer for application control and for a subjective evaluation of daily tolerability. RESULTS: In these subjects prone to occupational irritant contact dermatitis, the hand protectant cream applied during the initial 7-day period was effective in restoring the damaged skin barrier and improving the stratum corneum hydration. A regimen that combined the hand protectant and repair creams with a speci c cleanser during a further 7-day period allowed contin- ued improvement of skin hydration and additional clinical bene ts while respecting the skin barrier function. CONCLUSION: The results of this study support the use of a 3-step approach for patients who are at risk of repeated exposure to external irritants. J Drugs Dermatol. 2016;15(suppl 11):s81-85.
Skin prone to atopic dermatitis (AD) is commonly characterized by an impaired epidermal barrier that results in increased transepidermal water loss (TEWL) and leaves the skin rough, dry, and itchy.1 Subsequent scratching behavior further compromises the integrity of the skin, contributing to a cycle of inflammation.2 This “itch-scratch cycle” fuels the disease and likely leads to increased penetration of irritants, allergens, and infectious agents that cause persistent inflammation in the skin and may actually lead to the development of other immunologic alterations.2,3 Although the barrier defect has been considered a secondary phenomenon in some models,4 the most modern conception of the disease suggests that skin barrier function is a fundamental component of AD that must be addressed.5It is well established that appropriate moisturizers can help restore barrier function and alleviate symptoms of AD.6,7 Further, topical anti-itch preparations provide direct relief of pruritus but also likely work to abate the itch-scratch cycle.8 The anti-itch foam preparation used in the study was formulated with glycerol, a powerful humectant which also has anti-irritant, barrier-restoring, and even antimicrobial effects, all of which make it an excellent choice in patients with AD.9 Additionally, the foam contains a proprietary synthetic avenanthramide based on the active ingredient in colloidal oatmeal that possesses anti-irritant, anti-itch and antihistaminic properties.10,11 Remarkably, this component has been shown to actually reduce redness and itch in irritated skin as a monotherapy.12The objective of the present study was to investigate a topical anti-itch foam in skin barrier regeneration and itch alleviation.
MATERIALS AND METHODS
A single center open clinical study was performed. A total of 42 subjects were screened, and 26 subjects were enrolled (average age, 30.4; range, 21.6-44.7 years) with dry and pruritic skin who had previously been diagnosed with AD, but were without active lesions at enrollment (Table 1). One leg was treated with a single application of an anti-itch foam. Clinical scores for dryness, scaling, roughness, cracking, and clinical signs of scratching were assessed by a dermatologist before, 6, and 24 hours after the application. In addition, skin hydration was measured at 24 hours. The same product was applied twice daily for 7.5 days to the other leg. Skin hydration and TEWL were measured at baseline and on days 2, 8, and 10 by means of corneometry and tewametry. Volunteers assessed pruritus intensity during the study using