Challenging a paradigm: skin sensitivity to sodium lauryl sulfate is independent of atopic diathesis

Abstract

Background Sodium lauryl sulfate (SLS) is the best-studied detergent in irritant contact dermatitis. In atopic dermatitis, the two major pathophysiological abnormalities concern skin barrier function and regulation of cutaneous immune responses. The probability of atopic skin diathesis can be assessed by comprehensive analysis of patient history, as well as clinical and laboratory findings, resulting in the Erlangen Atopy Score (EAS). Objectives To investigate the impacts of (i) atopic skin diathesis according to the EAS and (ii) the physician-assessed diagnoses 'atopic dermatitis', 'allergic rhinitis' and 'allergic asthma' on SLS skin reactions. Methods This is a retrospective analysis of data from 2030 consecutive patients patch tested with SLS (0Á25% aqueous) from two tertiary referral centres in Germany, from 2008 to 2014. Results Patients with a high probability of atopic skin diathesis showed no significant increase in positive SLS reactions compared with patients without atopic skin diathesis (14Á2% vs. 16Á8%). The grading of positive SLS skin reactions (1-4) revealed no differences in patients with or without atopic skin diathesis. Furthermore, diagnoses of atopic dermatitis, allergic rhinitis or allergic asthma had no impact on positive SLS skin reactions in multivariate logistic regression analysis. Conclusions We found no association of increased skin irritability to SLS with atopic skin diathesis, atopic dermatitis, allergic rhinitis or allergic asthma in a large patient cohort. It therefore seems that the test of skin irritability with SLS, which is currently common practice in many centres, does not allow prediction of susceptibility to irritant eczematous inflammation in atopic vs. nonatopic individuals. What's already known about this topic? • Irritant contact dermatitis and atopic skin diathesis share impaired skin barrier function as a pathophysiological pattern. • Sodium lauryl sulfate (SLS) is tested at 0Á25% aqueous as an irritant control in patch testing, and hence the results might be affected by atopic skin diathesis. What does this study add? • Challenging a long-standing paradigm, we found no association of increased reactivity to SLS patch tests in individuals with atopic skin diathesis, atopic dermatitis, allergic rhinitis or allergic asthma in a large patient cohort. • Thus, irritant control testing with SLS, which is useful in interpreting doubtful allergen patch test results, does not depend on individual atopy status.

Fatty acid potassium improves human dermal fibroblast viability and cytotoxicity, accelerating human epidermal keratinocyte wound healing in vitro and in human chronic wounds

“…SLS has been used in skin patch tests, and discussed in terms of skin atopic diathesis, dermatitis, rhinitis, and asthma, which do not depend on the atopic status of the patient's skin. 21 SLES is a minor irritant to skin compared with SLS. 22 In a soak test, however, cutaneous capacitance was significantly reduced in an SLES‐treated region, even though SLES is used globally in personal care products because of its mildness and good foaming ability.…”

‘The need for dose–response studies: time for a reminder?’ – reply from the authors

“…Dear Editor , We read with great interest Sam Shuster’s comment 1 on our recently published study in this journal 2 . Perhaps the title of our paper triggered expectations in him that were not intended from our side.…”

Sodium lauryl sulfate: a never ending story?

“…The paper by Heetfeld et al . in this issue of the BJD challenges the paradigm that patients with atopic dermatitis display higher skin sensitivity to SLS than healthy controls. The authors performed a retrospective analysis of patch test patient data, including not only a clinical SLS test, but also the Erlangen atopy score as an indication of atopic skin diathesis.…”