Cutaneous inflammatory diseases, such as irritant contact dermatitis, are usually treated with topical corticosteroids, which cause systemic and local adverse effects limiting their use. Thus, the ...discovery of new therapeutic alternatives able to effectively treat skin inflammatory disorders, without causing adverse effects, is urgently needed.
Aim of the study: To investigate the topical anti-inflammatory effect of oleic acid (OA), a monounsaturated fatty acid, into Pemulen® TR2-based semisolid dosage forms, employing a croton oil-induced irritant contact dermatitis model in mice.
Male Swiss mice were submitted to skin inflammation protocols by acute and repeated applications of croton oil. The anti-inflammatory activity of Pemulen® TR2 hydrogels containing OA was evaluated by assessing oedema, inflammatory cell infiltration, and pro-inflammatory cytokine IL-1β levels. The mechanisms of action of OA were evaluated using cytokine IL-1β application or pretreatment with the glucocorticoid antagonist mifepristone. Possible toxic effects of OA were also assessed.
Pemulen® TR2 3% OA inhibited the acute ear oedema maximal inhibition (Imax) = 76.41 ± 5.69%, similarly to dexamethasone (Imax = 84.94 ± 2.16%), and also inhibited ear oedema after repeated croton oil application with Imax = 85.75 ± 3.08%, similar to dexamethasone (Imax = 81.03 ± 4.66%) on the day 7 of the experiment. Croton oil increased myeloperoxidase activity, which was inhibited by Pemulen® TR2 3% OA (Imax = 71.37 ± 10.97%) and by 0.5% dexamethasone (Imax = 96.31 ± 3.73%). Pemulen® TR2 3% OA also prevented the increase in pro-inflammatory cytokine IL-1β levels induced by croton oil (Imax = 94.18 ± 12.03%), similar to 0.5% dexamethasone (Imax = 87.21 ± 10.58%). Besides, both Pemulen® TR2 3% OA and 0.5% dexamethasone inhibited IL-1β-induced ear oedema with an Imax of 80.58 ± 2.45% and 77.46 ± 1.92%, respectively. OA and dexamethasone anti-inflammatory effects were prevented by 100% and 91.43 ± 5.43%, respectively, after pretreatment with mifepristone. No adverse effects were related to Pemulen® TR2 3% OA administration.
OA demonstrated anti-inflammatory efficacy similar to dexamethasone, clinically used to treat skin inflammatory conditions, without presenting adverse effects.
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•Hydrogels containing oleic acid reduce the croton oil-induced inflammation.•Oleic acid also reduces IL-1β-induced mice ear oedema.•Anti-inflammatory effect of oleic acid seems to occur via the glucocorticoid receptor.•Oleic acid did not present adverse effects among those evaluated.•Oleic acid could represent a therapeutic alternative to treat skin inflammation.
Abstract Background Incontinence- Associated Dermatitis (IAD) is one of the clinical manifestations of Moisture- Associated Skin Damage (MASD). IAD is a common problem in aged patients with faecal ...and/or urinary incontinence. Aim Update about IAD terminology, aetiology, epidemiology, observation, prevention, and treatment. Methods Integrative review. Results The lack of an ICD-10 codes and an internationally validated and standardized method for IAD data collection contribute to a variation in epidemiological data. Frequent episodes of incontinence (especially fecal), occlusive containment products, poor skin condition, reduced mobility, diminished cognitive awareness, inability to perform personal hygiene, pain, pyrexia, certain medications (antibiotics, immunosuppressant), poor nutritional status, and critical illness are associated with IAD. Correctly diagnosing IAD and distinguish it from pressure ulcers is difficult. Even though the clinical presentation of partial thickness pressure ulcers and IAD is similar, the underlying etiologic factors differ. However, incontinence and IAD were found to be risk factors for pressure ulcer development. IAD management should essentially focus on skin cleansing to remove dirt, debris and microorganisms; skin moisturization to repair or augment the skin's barrier; and the application of a skin barrier product to prevent skin breakdown by providing an impermeable or semi-permeable barrier on the skin. The body of evidence is still limited, buy growing since the last decade. Conclusion Incontinence causes disruptions of the skin barrier function and leads to superficial skin damage. Macerated skin and superficial skin changes due to incontinence are associated with pressure ulcer development. Skin maceration, chemical irritation, and physical irritation should be targeted to effectively prevent and treat IAD.
Patch testing is an important diagnostic tool for suspected allergic contact dermatitis (ACD) in occupational settings.
Provide an overview of occupational skin disease (OSD) and an analysis of ...occupational ACD in North American patients undergoing patch testing between 2001and 2016.
Patients with OSD were analyzed for frequency of allergic reactions to a screening series of allergens, occupational relevance, location of skin disease, and exposure sources. Demographic, occupation, and industry information were recorded.
Of 38,614 patients evaluated, 4471 (11.6%) had OSD, of whom 3150 (70.5%) had ACD. The most common occupationally related allergens included rubber accelerators, preservatives, and bisphenol A epoxy resin. Hands (75.8%), arms (30.0%), and face (15.9%) were common sites of dermatitis. The occupations most affected were service workers and machine operators.
Our cohort may not reflect the general working population.
This study identified common occupational allergens, exposure sources, and occupations/industries at risk. This information may help the clinician evaluate and manage patients with occupational contact dermatitis.
To review of contact dermatitis (CD) and its key allergens and provide updates and recommendations for the practicing allergist.
Through the use of various scientific search engines (eg, PubMed and ...MEDLINE), we reviewed literature on CD, patch tests (PTs), key allergens, occupational dermatitis, and treatment.
Studies on CD, important allergens, and PTs were considered.
Contact-induced dermatitis may be due to allergic CD, irritant CD, systemic CD, contact urticaria, and protein CD. Key allergens include metals (nickel, gold), topical medicaments (topical corticosteroids), and cosmetics and personal care products (fragrances and preservatives such as methyl- and methylchloro-isothiazolinone). Present relevance of a positive PT result is the combination of definite, probable, and possible relevance and should be correlated with the patient's history and physical examination. Treatment of allergic CD includes identification of relevant allergens, patient education, avoidance, and provision of alternative products the patient can use.
CD is a common inflammatory skin disease and should be suspected in patients presenting with acute, subacute, or chronic dermatitis. The gold standard for diagnosing allergic CD is a PT. This article provides practical recommendations for the diagnosis and management of CD commonly seen by the allergist in their practice.
Irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD) are common skin disorders that are characterized by inflammation, oozing, crusting, and pruritus. Atopic dermatitis (AD) is an ...inflammatory skin disease characterized by immune and barrier abnormalities and is additionally a risk factor for acquiring ICD and ACD. New work on allergic sensitization to common allergens (e.g., nickel and fragrance) in human skin has shown that different allergens have distinct molecular fingerprinting. For example, nickel promotes strong Th1/Th17 polarization, whereas fragrance allergy causes Th2/Th22 skewing, which is similar to the phenotype of AD. While ACD has previously been considered to be constant across all allergens, largely based on mouse models involving strong sensitizers, these new data suggest that ACD differs mechanistically according to allergen. Further, ACD in the setting of concurrent AD shows a different and attenuated phenotype as compared to healthy individuals with ACD, which influences the way AD patients respond to vaccination and other treatment modalities. As in contact sensitization, skin challenged by food patch testing shows that common food allergens (e.g., peanut and barley) also cause distinct immune polarizations in the skin. Additionally, house dust mite reactions in human skin have been profiled to show unique Th2, Th9, and Th17/22 activation as compared to controls, which are similar to the phenotype of psoriasis and contact responses to nickel. Given this information, ACD patients should be treated based on their unique allergen polarity. Refined understanding of the molecular behavior of contact dermatitis and related diseases translates to improved methods of inducing tolerance in sensitized allergic patients, such as with targeted drug therapy and epicutaneous immunotherapy.
- Contact skin lesions may be the consequences of contact with various irritants or allergens, or due to other factors (e.g., UV radiation, microbials), intrinsic factors (e.g., in autoimmune ...responses), or even their combination. There are many substances related to irritant contact dermatitis (CD), causing irritant or toxic effects, e.g., chemical and physical agents, plants, phototoxic agents, airborne irritants, etc. Impaired barrier function (e.g., aberrancies in epidermal pH buffering capabilities) also participates by promoting bacterial biofilms and creating an environment favoring sensitization. Development of allergic CD skin lesions includes complex immune pathways and inflammatory mediators, influenced by both genetic (predominantly filaggrin mutations) and environmental triggers. In the pathogenesis of allergic CD, antimicrobial peptides play a prominent role; they are produced by various skin cells (e.g., keratinocytes, sebocytes) and move to inflamed lesions during an inflammation process. Also, in allergic CD skin lesions, the skin shows different types of immune responses to individual allergens, although clinical manifestations do not depend on the causative allergen type, e.g., nickel stimulates immune activation primarily of the Th1/Th17 and Th22 components. Also important are alarmins, proteases, immunoproteomes, lipids, natural moisturizing factors, tight junctions, smoking, etc. We expect that future perspectives may reveal new pathogenetic factors and scientific data important for the workup and treatment of patients with CD.
Personal care products (PCPs) are commonly responsible for allergic contact dermatitis and irritant contact dermatitis. PCP use was historically associated with females, but male-targeted PCPs are ...increasingly being marketed.
To characterize and compare males with PCP-related contact dermatitis (MPCPs) and females with PCP-related contact dermatitis (FPCPs).
This was a retrospective cross-sectional analysis of North American Contact Dermatitis Group data (1996-2016).
Four thousand six hundred eighty of 16,233 men (28.8%) and 12,730 of 32,222 (39.5%) women had a PCP identified as a source of irritant contact dermatitis or a positive patch test reaction. The proportion of PCP-related dermatitis in both sexes significantly increased (>2.7-fold) over the decade of study. Compared with FPCPs, a larger proportion of MPCPs were older or had trunk or extremity dermatitis (P < .0001). MPCPs were twice as likely to have soaps as a source while FPCPs were twice as likely to have hair care products (P < .0001). The most common PCP-related North American Contact Dermatitis Group allergens for both sexes were methylisothiazolinone (MPCP 28.8% and FPCP 21.5%), fragrance mix I (MPCP 22.3% and FPCP 20.1%), balsam of Peru (MPCP 18.5% and FPCP 14.1%), quaternium-15 (MPCP 16.1% and FPCP 12.3%), and paraphenylenediamine (MPCP 11.5% and FPCP 11.1%).
Patient population referred for suspected contact dermatitis.
PCP-related dermatitis is increasing. Sites of involvement and relevant PCP sources are distinct between sexes. Male and female variation in exposure history may explain differences in reactivity to some allergen groups.
Summary
Fibreglass dermatitis is a common occupationally acquired irritant contact dermatitis, where small spicules of fibreglass lodging in the stratum corneum result in mechanical irritation. We ...present two patients, an air-conditioning ducting worker and an injection moulding machine operator, who both presented with generalized pruritus. In the first case, polarized microscopy of a skin biopsy specimen demonstrated rare small spicules, with a diameter of 1 µm, lodged in the stratum corneum. In the second case, skin tape stripping demonstrated fibreglass particles, not found on skin biopsy. Proper work practices, personal hygiene and use of impervious barrier materials were recommended. The first patient did not return for follow-up, and the second patient’s dermatitis resolved after handling of fibreglass-containing material was eliminated from his job scope. In conclusion, we present two cases of fibreglass dermatitis to illustrate the challenges in diagnosis and highlight strategies for prevention.
Fibreglass dermatitis is an occupationally acquired irritant contact dermatitis with varied clinical presentations, sometimes manifesting only as pruritus without an apparent dermatosis. We report two cases of fibreglass dermatitis, confirmed with skin biopsy in one and skin tape stripping in the other. We discuss the use of workplace controls and personal protective equipment to prevent its occurrence.
Contact dermatitis (CD) is among the most common inflammatory dermatological conditions and includes allergic CD, photoallergic CD, irritant CD, photoirritant CD (also called phototoxic CD) and ...protein CD. Occupational CD can be of any type and is the most prevalent occupational skin disease. Each CD type is characterized by different immunological mechanisms and/or requisite exposures. Clinical manifestations of CD vary widely and multiple subtypes may occur simultaneously. The diagnosis relies on clinical presentation, thorough exposure assessment and evaluation with techniques such as patch testing and skin-prick testing. Management is based on patient education, avoidance strategies of specific substances, and topical treatments; in severe or recalcitrant cases, which can negatively affect the quality of life of patients, systemic medications may be needed.
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