Thoughts on irritant contact dermatitis

Malten, K. E.

doi:10.1111/j.1600-0536.1981.tb04059.x

Cited by 212 publications

(74 citation statements)

References 12 publications

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“…The incremental increase in disruption seen after each wash supports the concept of a cumulative skin response to repeated irritation. 30 Similarly Malten 31 proposed that damage to the skin barrier can be compensated for providing there is sufficient time between insults, but that the frequent, accumulative exposure to low-grade irritants (as would occur in the care of an individual with incontinence) does not allow adequate time for barrier repair, leading to an inflammatory response and skin breakdown. The use of plain water also caused an increase in the rate of TEWL, although this was less pronounced when cold air drying was used.…”

Section: ■ Discussionmentioning

confidence: 99%

The Effect of Washing and Drying Practices on Skin Barrier Function

Voegeli

2008

Journal of Wound, Ostomy &Amp; Continence Nursing

109

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PURPOSE:The aim of this study was to explore the potential contribution to skin damage caused by standard washing and drying techniques used in nursing.DESIGN: An experimental cohort design was used, with healthy volunteers (n = 15) receiving 6 different washing and drying techniques to the volar aspect of the forearm. Subjects underwent 3 washing and drying techniques on each arm; each technique was repeated twice, separated by a 2-hour rest period. METHODS:Skin integrity was assessed by measuring transepidermal water loss (TEWL), skin hydration, skin pH, and erythema. Comparisons were made between washing with soap or water alone, and drying using a towel (rubbing and patting) or evaporation. The significance of any difference was assessed by nonparametric analysis. The study was approved by the local research ethics committee, and all volunteers gave informed consent. RESULTS:TEWL was seen to increase following each type of wash, and increased further following repeated washing. Drying of the skin by patting with a towel increased TEWL to give readings identical to those obtained from wet skin. There was an increase in skin pH with all washing and drying techniques, particularly when soap was used. Erythema also increased with repeated washing, particularly when soap was used. No significant changes were observed in skin hydration as measured by a corneometer, although there was a tendency for the values to decrease with washing.CONCLUSIONS: These data suggest that washing with soap and water and towel drying has a significant disrupting effect on the skin's barrier function. There is tentative evidence to suggest that a cumulative effect may exist with damage increasing as washing frequency increases. Drying the skin by patting with a towel offers no advantage to conventional gentle rubbing as it leaves the skin significantly wetter and at greater risk of frictional damage. ■ IntroductionThe promotion and maintenance of skin integrity remains one of the most common challenges facing healthcare professionals. Estimates suggest that basic skin care, consisting of washing and drying patients, accounts for 12% to 17% of total nursing time in a typical acute care setting. 1 However, this activity increases significantly during the care of individuals with urinary or fecal incontinence, as washing and drying forms the cornerstone of skin care for this group, in order to prevent irritation and skin breakdown. Globally it is suggested that over 200 million people suffer from significant urinary incontinence, and therefore are at risk of skin breakdown. 2 In the United Kingdom alone, Durrant and Snape 3 suggest that 50% of nursing home residents have urinary incontinence, and overall incidence rates of 40% to 70% in the UK elderly population are reported by the Royal College of Physicians. 4 Early work by Lyder 5 claimed that perineal dermatitis and skin breakdown occurs in 35% of hospitalized elderly patients with incontinence, rising to 41% of individuals in long-term care settings, demonstrating the significance ...

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Section: ■ Discussionmentioning

confidence: 99%

The Effect of Washing and Drying Practices on Skin Barrier Function

Voegeli

2008

Journal of Wound, Ostomy &Amp; Continence Nursing

109

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“…The strongest influence on manifestations of irritant skin changes is by far the individual's behaviour. When mild irritations like hand washing are affecting the skin frequently, the regenerating mechanism can no longer maintain a sufficient barrier 30) . The skin barrier becomes more and more disrupted and further irritation may occur more easily.…”

Section: Pathogenesis Of Occupational Hand Dermatitismentioning

confidence: 99%

Prevention of Irritant Contact Dermatitis among Health Care Workers by Using Evidence-Based Hand Hygiene Practices: A Review

Kampf

Löffler

2007

INDUSTRIAL HEALTH

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Irritant contact dermatitis is often found on the hands of healthcare workers and is generally caused by frequent hand washing, gloves, aggressive disinfectants or detergents. Alcohols have only a marginal irritation potential, although they may cause a burning sensation on pre-irritated skin. A burning sensation when using alcohols therefore, suggests that the skin barrier is already damaged. Two options for hand hygiene are generally available in clinical practice: (1) hand washing with some type of soap and water or (2) hand disinfection with alcohol-based hand rubs. Most clinical situations require the use of an alcohol-based hand rub for decontamination, which is especially useful for reducing the nosocomial transmission of various infectious agents. Washing one's hands should be the exception, to be performed only when they are visibly soiled or contaminated with proteinaceous material, or visibly soiled with blood or other body fluids. The overall compliance rate in hand hygiene is around 50%, which is far too low. In addition, healthcare workers quite often wash their hands with soap and water, when they should use an alcohol-based hand rub. This not only adds to the degree of skin irritation, but is also potentially dangerous for patients, due to the low efficacy of hand washing when compared to hand disinfection with alcohol rubs. Adhering to evidence-based hand hygiene protocols and following international guidelines on hand hygiene practices therefore, can help prevent irritant contact dermatitis among healthcare workers.

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“…Although more-refined patch testing methods have increased the detection rate of (delayed-type) allergic contact dermatitis, most cases belong to the category of irritant contact dermatitis. This type is assumed to be the result of an accumulation of exposure to relatively weak toxic stimuli, which leads via a stage of clinically in-visible damage to manifest "cumulative insult" dermatitis (7). Inherent skin toxicity of various substances can be assessed in animal tests and is theoretically also possible in humans.…”

mentioning

confidence: 99%

Changes in water vapor loss from the skin of metal industry workers monitored during exposure to oils.

Coenraads¹,

Lee²,

Pinnagoda³

1986

Scand J Work Environ Health

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Changes in water vapor loss from the skin of metal industry workers monitored during exposure to oils. by Coenraads PJ, Lee J, Pinnagoda J This article in PubMed: www.ncbi.nlm.nih.gov/pubmed/2947320 Environ Health 12 (1986) [494][495][496][497][498] Changes in water vapor loss from the skin of metal industry workers monitored during exposure to oils by Pieter-Jan Coenraads MD, MPH, James Lee, MSe, PhD, Jaliya Pinnagoda, SSe 1 COENRAADS P-J, LEE J, PINNAGODA 1. Changes in water vapor loss from the skin of metal industry workers monitored during exposure to oils. Scand J Work Environ Health 12 (1986) 494-498. Vapor loss (VL) from nonsweating skin (SVL), a surrogate measure for transepidermal water passage, was ascertainedelectronically from 54 newlyrecruited metal workers. A weekly measurementwas taken for 12 weeks from each worker in the three groups studied: 17 unexposed workers, 13 workers exposed to water-soluble oilsand 24workersexposed to straightmineraloil. Duringthe 12-week periodfour workers in the group exposedto mineral oil developed contact dermatitis, with a markedlyincreasedSVL.Among the 50 workers whose skin remained normal, the mean initial SVL was 6.8 g . m-2 • h-1 for the back of the hand, 4.4 for the extensor, and 4.7 for the volar forearm. There was a slight but nonsignificantincrease in all three SVL levels in the group exposed to water-soluble oils as compared to the unexposed group. In the group exposedto mineral oils the SVL of the extensor and volar forearm rose to a significantly higher level as compared to those of the unexposed group. This difference persisted after statistical adjustment for age, sex, ethnic group, and initial SVLlevel. These findings indicate that SVL measurement has potential as a monitoring parameter for workersat risk of occupational contact dermatitis.

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Thoughts on irritant contact dermatitis

Cited by 212 publications

References 12 publications

The Effect of Washing and Drying Practices on Skin Barrier Function

The Effect of Washing and Drying Practices on Skin Barrier Function

Prevention of Irritant Contact Dermatitis among Health Care Workers by Using Evidence-Based Hand Hygiene Practices: A Review

Changes in water vapor loss from the skin of metal industry workers monitored during exposure to oils.

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