Harald Löffler

Stratum corneum adhesive tape stripping: influence of anatomical site, application pressure, duration and removal

Background  Tape stripping is a common method for investigating stratum corneum (SC) physiology as well as bioavailability and bioequivalence of topical drugs.

Patch testing with contact allergens

One-year prevalence of contact dermatitis in the general population is 7%. 15 to 20% of the general population are sensitized to one of the common allergens [1, 2]. Contact dermatitis is the subject of a current guideline of the German Dermatologic Society (Deutsche Derma tologische Gesellschaft, DDG) [3]. The patch test is the only instrument suitable for routine diagnostics to prove sensitization to a substance causing an allergic contact dermatitis. Synchronous reproducibility ranges from 60 to 90 %, depend ing on test method and allergen [4, 5].

How irritant is alcohol

Summary Background  Alcohol‐based hand rubs are used worldwide to prevent transmission of nosocomial pathogens.

Hand Hygiene for the Prevention of Nosocomial Infections

BACKGROUND The WHO regards hand hygiene as an essential tool for the prevention of nosocomial infection, but compliance in clinical practice is often low. METHODS The relevant scientific literature and national and international evidence-based recommendations (Robert Koch Institute [Germany], WHO) were evaluated. RESULTS Hygienic hand disinfection has better antimicrobial efficacy than hand-washing and is the procedure of choice to be performed before and after manual contact with patients. The hands should be washed, rather than disinfected, only when they are visibly soiled. Skin irritation is quite common among healthcare workers and is mainly caused by water, soap, and prolonged wearing of gloves. Compliance can be improved by training, by placing hand-rub dispensers at the sites where they are needed, and by physicians setting a good example for others. CONCLUSIONS Improved compliance in hand hygiene, with proper use of alcohol-based hand rubs, can reduce the nosocomial infection rate by as much as 40%.

Differences of skin irritation between Japanese and European women.

Background  After using cosmetics, Japanese women frequently complain about sensitive, stinging skin. We wondered whether Japanese womens skin is more sensitive than that of Caucasians.

Primary prevention in health care employees: a prospective intervention study with a 3-year training period.

Irritant contact dermatitis is a mayor problem in health care employees. Because educational programs have shown convincing success in certain occupations (e.g. in hairdressers), this study investigates the effect of a special training program in health care trainees. 521 trainees from 14 nursing schools in Central Germany were randomly divided in 2 groups, (i) an intervention group with a regular teaching protocol regarding all aspects of primary prevention and (ii) a control group without any further teaching. Morphological changes of the hands, use of hand care creams and knowledge regarding skin care were evaluated regularly during their 3 years lasting training period (1999–2002). In the intervention group, we found at the end of the 3‐year training period a significant better skin condition of the hands than in the control group: a 3‐year prevalence of morphological skin changes of 66.7% versus 89.3%. The unteached trainees (control group) had an odds ratio (OR) of 4.8 [95% confidential interval (CI): 2.9–7.8] for developing any skin changes on the hands after 3 years. Besides the effect of the teaching, the history of hand dermatitis before the study start was an independent risk factor for development of further hand dermatitis [OR 1.9, 95% CI: 1.0–3.6). Age and sex showed no influence on the skin condition. Atopic constitution had an influence on the development of skin changes only at the evaluation after 18 month. The observed effect in the intervention group may best be explained by different behaviour of the trainees, e.g. the amount of hand washing was reduced, while procedure of hand disinfection remained unchanged compared with the control group. However, the amount of used skin care cream did not differ between the both groups. This study shows that primary prevention of skin disease by regularly teaching during the training period of medical employees can effectively reduce the risk of development of irritant skin changes of the hands. Therefore, teaching and continuous motivation regarding preventive individual and collective measures during the training of medical staff should be an obliged part of the curriculum.

The influence of body mass index on skin susceptibility to sodium lauryl sulphate.

Background:  The influence of nutrition on the physiological functions of man is well studied. Numerous diseases can be exacerbated by obesity. However, it has not yet been determined whether body weight and body mass index (BMI), as an indicator of a high body fat store, can influence skin sensitivity.

Epidermal cytokines in murine cutaneous irritant responses.

Investigations on cytokines in skin irritancy or non‐immunological irritant contact dermatitis (ICD) should improve our understanding of their complex mechanism. Numerous studies showed, however, that similar epidermal cytokines have been detected in irritant and allergic reactions, suggesting a lack of specific cytokines that clearly differentiate allergic from irritant reactions even though the pathomechanisms between allergic contact dermatitis (ACD) and ICD are distinguished. Recent data, however, indicate that some mediators may be restricted to allergic responses (contact hypersensitivity). This could provide the impetus to study their implication on irritant reactions. We overview the epidermal cytokines involved in irritant responses compared to those in contact hypersensitivity based on published results of studies using in vitro cell‐cultured murine keratinocytes and in vivo murine models. Copyright

Skin susceptibility of atopic individuals.

The relevance of the irritant skin reaction of individuals with an atopic history (atopic dermatitis, rhinoconjunctivitis or atopic asthma) to sodium lauryl sulfate (SLS), a widely used irritant, is still controversial. The aim of this study was to evaluate transepidermal water loss (TEWL) as an indicator of stratum corneum integrity, before and after SLS patch testing, in various groups of atopic individuals with and without atopic dermatitits. 95 volunteers were divided into 4 groups: (1) individuals with active atopic dermatitis; (2) individuals with a history of atopic dermatitis but without active skin lesions; (3) individuals with rhinoconjunctivitis or atopic asthma without any symptoms at the time of testing; (4) healthy individuals serving as controls. The volunteers were patch‐tested at the unaffected volar side of the forearm with aqueous SLS 0.5% for 48 h. TEWL was measured before application and after removal of the patch. Individuals with active atopic dermatitis showed a significantly higher TEWL value after SLS and a tendency to a higher basal TEWL as compared to the 3 other groups. There were no significant differences in TEWL between individuals who were classified as atopic but without active dermatitis, individuals with rhinoconjunctivitis or atopic asthma and healthy controls, either at the basal or at the post‐SLS measurement. Enhanced skin susceptibility is only present in individuals with active dermatitis. The skin susceptibility of atopic individuals might therefore be increased as soon as the skin becomes ec‐zematous, suggesting a reduced epidermal integrity probably caused by the endogenous atopy and/ or respiratory allergens. When interpreting the atopy score in relation to skin susceptibility, the actual condition of the skin should hence be taken into consideration.

Effects of disinfectants and detergents on skin irritation

We investigated the biological response of regular human skin to alcohol‐based disinfectants and detergents in a repetitive test design. Using non‐invasive diagnostic tools such as transepidermal water loss, laser‐Doppler flowmetry and corneometry, we quantified the irritative effects of a propanol‐based hand disinfectant (Sterillium®), its propanol mixture (2‐propanol 45% w/w and 1‐propanol 30% w/w), sodium lauryl sulfate (SLS) 0.5% and distilled water. The substances were applied in a 2‐D patch test in a repetitive occlusive test design to the back. Additionally, we performed a wash test on the forearms that was supposed to mimic the skin affection in the normal daily routine of health care workers. In this controlled half‐side test design, we included the single application of the hand rub, SLS 0.5% and water as well as a tandem application of the same substances. Patch test and wash test showed similar results. The alcohol‐based test preparations showed minimal irritation rather comparable to the application of water. However, the detergent SLS produced stronger barrier disruption, erythema and dryness than the alcohol‐based preparations. There was no additional irritation at the combined use of SLS and disinfectants. By contrary, there was even a decrease in barrier disruption and erythema induced by the tandem application of SLS followed by alcohol‐based disinfection compared with the use of SLS alone. These findings show a less irritant effect of alcohol‐based disinfectants on the skin than detergents. Our study shows that there is no summation of irritating effects of a common detergent and propanol and that the combination of washing and disinfection has a rather protective aspect compared with washing alone.