SummaryBackgroundThe irritant sodium lauryl sulfate (SLS) is known to cause a decrease in the stratum corneum level of natural moisturizing factor (NMF), which in itself is associated with changes in corneocyte surface topography.ObjectiveTo explore this phenomenon in allergic contact dermatitis.MethodsPatch testing was performed on patients with previously positive patch test reactions to potassium dichromate (Cr), nickel sulfate (Ni), methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI), or p‐phenylenediamine. Moreover, a control (pet.) patch and an irritant (SLS) patch were applied. After 3 days, the stratum corneum from tested sites was collected, and NMF levels and corneocyte morphology, expressed as the amount of circular nanosize objects, quantified according to the Dermal Texture Index (DTI), were determined.ResultsAmong allergens, only MCI/MI reduced NMF levels significantly, as did SLS. Furthermore, only MCI/MI caused remarkable changes at the microscopic level; the corneocytes were hexagonal‐shaped with pronounced cell borders and a smoother surface. The DTI was increased after SLS exposure but not after allergen exposure.Conclusions MCI/MI significantly decreased NMF levels, similarly to SLS. The altered corneocyte morphology suggests that skin barrier damage plays a role in the pathogenesis of MCI/MI contact allergy. The DTI seems to differentiate reactions to SLS from those to the allergens tested, as SLS was the only agent that caused a DTI increase.

Cytokine profiles in the SC of patch tested skin did not show a distinct allergen-specific pattern. However, MCI/MI induced a larger and wider immune response than the other allergens, perhaps due to its potency as an irritant. The levels of IL-16 were significantly increased in patch test reactions to allergens but not to SLS; thus, they may help clinicians to differentiate between allergic contact dermatitis and irritant contact dermatitis.

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Skin conditions are among the most prevalent and disabling diseases affecting millions of people worldwide. Recently, there have been significant changes in dermatologic clinical practice. Advances in knowledge of disease pathophysiology have led to significant breakthroughs in diagnostics and therapy, as well as discovery of new treatment modalities. Additionally, research focusing on differences between individual patients has resulted in the growth of personalized medicine. Health care professionals are focusing on tailoring therapy to the individual characteristics of each patient, which in turn leads to improved quality of care and management of each individual. Of note, patient safety may be compromised when applying or taking dermatologic therapy as a result of medical error, patient noncompliance, adverse effects, or drug interactions. It is therefore of great importance to minimize, and if possible prevent these risks. Finally, the appraisal of health care goods and services currently does not only analyze the safety and efficacy of treatment, but also considers the economic impact on the cost of health care. Consequently, pharmacoeconomic evaluation has become an essential step in the introduction of new dermatologic treatments and the rational use of pharmaceuticals.

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