Dermatologic Laser Side Effects and Complications: Prevention and Management

The evolution of modern laser and light-based systems has mirrored the demand for clinically effective treatments and the need for safer technologies with reduced postoperative recovery, side effects, and complications. With each new generation of lasers, more selective tissue destruction can be achieved with reduced unwanted sequelae. Patient selection and preparation, operator technique, and expeditious recognition and management of post-treatment side effects are paramount in avoiding complications and patient dissatisfaction. An overview of important variables to consider for dermatologic laser treatments are presented in order to provide a framework to reduce the severity and duration of possible post-treatment side effects and complications.

Development and validation of the incontinence associated dermatitis knowledge, attitude and practice questionnaire

AIM

This study aimed to develop and test the validity and reliability of the Knowledge, Attitudes and Practices of Incontinence-associated Dermatitis Questionnaire (KAP-IAD-Q) for Nurses.

METHODS

A psychometric validation design was employed. Phase I of the study entailed the development of items through an extensive literature review and a double Delphi procedure with 11 experts specialised in wound, ostomy and continence to examine content validity of the KAP-IAD-Q. Phase II involved administering the KAP-IAD-Q to a convenience sample of 263 Registered Nurses from a public hospital in Singapore to evaluate its construct validity, internal consistency and test-retest reliability.

RESULTS

The instrument showed acceptable content validity (S-CVI = 0.85). Exploratory factor analysis showed all 22 items demonstrated strong factor loadings >0.4 and the four factors KAP-IAD-Q explained 58.1% of total variance. The four factors were☹1) knowledge om IAD aetiology and identification, (2) knowledge on IAD risk factors; (3) attitudes, and (4) practices. The overall internal consistency was excellent (Cronbach's α = 0.913). The KAP-IAD-Q showed good overall test-retest reliability as well (ICC = 0.89 (95% CI 0.69-0.96, p < 0.001).

CONCLUSION

The KAP-IAD-Q demonstrated good psychometric properties and is effective in measuring levels of IAD-related KAP among nurses. Further confirmation of the proposed factor structure is recommended. Future research should explore determinants of nurses' KAP and associations between IAD knowledge, attitudes and practices.

Exopolysaccharide Produced by Lactobacillus paracasei IJH-SONE68 Prevents and Improves the Picryl Chloride-Induced Contact Dermatitis

Allergic disease is one of the most important and common health problems worldwide. We have previously demonstrated that a fig leaf-derived lactic acid bacterium Lactobacillus (Lb.) paracasei IJH-SONE68 produces a novel exopolysaccharide (EPS). Furthermore, we have shown that the EPS inhibits the catalytic activity of hyaluronidase (EC 3.2.1.36) promoting inflammatory reactions. To evaluate the anti-allergy and anti-inflammatory effects of the EPS, in the present study, we employed the picryl-chloride-induced delayed-type (type IV) allergy model mice, which is used to evaluate the contact dermatitis. Oral administration of the EPS was observed to reduce the ear swelling in the model mice. We also observed that the overexpression of ear interleukin-4 (T helper (Th) 2 cytokine) mRNA and the increase in serum immunoglobulin E (IgE) are repressed. However, the expression of interferon-γ (Th1 cytokine) was not accelerated in all of the allergen-challenged model mice. The improvement may be responsible for the Th2 downregulation rather than the Th1 upregulation. In addition, the symptom of immediate-type (type I) allergy model mice was improved by oral administration of the IJH-SONE68 cell (data not shown). We can conclude that the IJH-SONE68-derived EPS is useful to improve the type I and IV allergies including atopic dermatitis.

Inhibitory effects of dietary soy isoflavone and gut microbiota on contact hypersensitivity in mice

Soy isoflavones (SIs) are abundant in soybeans and have inhibitory effects on contact hypersensitivity (CHS), which is often used as a mouse model for allergic contact dermatitis (ACD); however, their therapeutic mechanisms remain unknown. We studied the suppressive activity of dietary SI and gut microbiota on dinitrofluorobenzene (DNFB)-induced CHS. Low-dose SI diets alleviated DNFB-induced ear swelling and oedema and decreased infiltration of Gr-1-positive cells into ear tissue. In addition, dietary SIs also decreased interleukin-1β and chemokine (C-X-C motif) ligand 1 production in ear tissue compared to controls. Furthermore, ciprofloxacin and metronidazole treatments blocked the suppressive activity of dietary SIs on CHS, whereas vancomycin treatment had a marginal effect. These antibiotic treatments differed in their effects on the gut microbiota composition. These results demonstrated that consumption of physiologically relevant doses of SIs reduced CHS symptoms, and suggested that the gut microbiota influenced their suppressive activities on CHS.

Cultivating Incontinence-associated Dermatitis Prevention Practices in an Australian Local Health District: A Quasi-experimental Study

Incontinence-associated dermatitis (IAD) is a common, painful, difficult-to-treat skin condition.

PURPOSE

A 2-part, quasi-experimental, post-test study was conducted to evaluate the impact of prevention initiatives on IAD prevalence and incontinence practices.

METHOD

In part 1, from May 2017 to November 2017, a quasi-experimental post-test study design was conducted in a health district in Australia. Following an audit of IAD prevalence and identification of evidence practice gaps in 4 hospitals in a local health district (12 wards, 250 patients), an implementation science approach was used to implement evidence-based initiatives. An IAD committee was formed, staff were educated about correct incontinence pad sizing, washable and disposable underpads and plastic sheets were removed from the care setting, and barrier cream cloths for cleansing, moisturizing, and protecting skin were introduced. Patients admitted to 1 of the 12 wards who were ≥18 years of age were recruited for participation and evaluation in the post-intervention implementation IAD and incontinence care practices audit. Post-intervention data were entered into a software program and compared to pre-implementation data using descriptive and bivariate statistics. In part 2, nurses from the 12 wards were asked to participate in 1 of 6 focus groups to share their impressions about the barrier cream cloths. Discussions were transcribed verbatim and analyzed using descriptive content analysis.

RESULTS

The rate of incontinence among audited patients (N= 259, 132 men, 124 women; mean age 73.2 ± 16.8 years) was 47.2% (119/252) and 2/259 (0.8%) had a pressure injury (PI). IAD prevalence was significantly lower in the post- than in the pre-implementation audit (6/259 vs 23/250, P = .015), as was hospital-acquired pressure injury (9/250 [3.6%] vs 2/259 [0.08%]) and the use of bed protection layers (154/238 vs 6/259; P <.01). The focus groups included 31 nurses (25 women, 6 men). Four (4) themes emerged: 1) benefits to the patient (eg, improved skin condition), 2) usability (eg, fewer steps), 3) problems encountered (eg, not seeing the barrier in place), and 4) related factors. Patient comfort was cited frequently as an important benefit.

CONCLUSION

Evidence-based initiatives led to a significant reduction in IAD prevalence and improved incontinence care practices. .

The Blend of Taurine and Aloe Vera Extract Boosts Action Against Skin Irritation: In Vitro and Clinical Evaluations

Regular usage of cosmetic products and drugs in dermatological vehicles may cause irritant contact dermatitis. For example, aluminum chloride (AlCl₃), the most efficacious antiperspirant salt to treat hyperhidrosis, shows high irritancy potential. To mitigate the irritant contact dermatitis caused by topical application of products containing AlCl₃, we investigated the anti-irritating effects of aloe extract and taurine in vitro and in vivo. In an in vitro experiment, reconstructed human epidermis model, EpiDerm, was tested with AlCl₃ in the presence or absence of taurine and aloe extract. In a human clinical study, 12 adult subjects were tested with two products, a commercial AlCl₃ antiperspirant product and a prototype 12% AlCl₃ formulation containing 0.1% taurine and 0.1% aloe extract. Skin irritation potential in vitro and in vivo was measured by the release of pro-inflammatory cytokine, IL-1α, and chemokine, IL-8. Taurine and aloe extract significantly (p < 0.05) reduced IL-lα and IL-8 production in vitro and in vivo after topical application of formulations containing AlCl₃. The blend of taurine and aloe extract demonstrated boosted anti-irritation benefits on AlCl₃ irritated skin both in vitro and in vivo. These results suggest that the combination of these anti-irritating actives may possibly be effective in mitigating irritant contact dermatitis caused by other dermatological vehicles containing irritating agents, but further research is warranted to assess their effects.

Anti-proliferative and anti-inflammatory effects of 3β,6β,16β-Trihydroxylup-20(29)-ene on cutaneous inflammation

ETHNOPHARMACOLOGICAL RELEVANCE

3β,6β,16β-Trihydroxylup-20(29)-ene (TTHL) is a triterpene isolated from the flowers of Combretum leprosum, a plant used in folk medicine in the north of Brazil for the treatment of skin disorders.

AIM OF THE STUDY

In the present study, TTHL was evaluated as a potential topical anti-inflammatory and anti-proliferative agent through in vivo and in vitro models.

MATERIAL AND METHODS

Anti-inflammmatory and anti-proliferative effects of TTHL were assessed using Swiss mice in acute and chronic models of skin inflammation induced by 12-O-tetradecanoylphorbol-acetate (TPA) application. Anti-proliferative activity was proved through in vitro experiments with the HaCaT human keratinocyte cell line.

RESULTS

Treatment with TTHL inhibited inflammatory parameters such as oedema formation and cellular infiltration in acute and chronic models. In the chronic model, TTHL also inhibited epidermal hyperproliferation, as evidenced by reduction of epidermis thickness and proliferating cell nuclear antigen expression. The anti-proliferative effect was confirmed by the capability of TTHL in reducing the proliferation and inducing cell apoptosis of HaCaT cells. Suggesting a mechanism of action, TTHL showed activation of corticosteroid receptors, but without the induction of corticosteroid-related cutaneous side effects.

CONCLUSION

Our results demonstrate consistent anti-inflammatory and anti-proliferative activity and assign TTHL as a valuable tool in the development of a new treatment for skin inflammatory and proliferative diseases, such as psoriasis.

Functional Food und Bioverfügbarkeit im Zielorgan Haut

Reactive free radicals can be produced in the skin by the action of environmental factors, such as sun radiation and toxins. These radicals can damage the DNA, proteins and lipids of the living cells. The consequences can be skin aging, immune suppression and even skin cancer. Humans have developed a protective mechanism against the action of free radicals in the form of antioxidant substances. Several of these antioxidants cannot be produced by humans and have to be acquired via food, such as carotenoids. Optical, non-invasive methods, like resonance Raman spectroscopy, allow a qualitative and quantitative online detection of the kinetics of antioxidants such as carotenoids in the skin. By employing this method it has been shown that the uptake of carotenoids in food can lead to an accumulation in the skin. On the other hand, stress, illness and UV-radiation can reduce the concentration of antioxidant substances in the skin. A high concentration of antioxidant substances is protective and associated with a reduction in skin wrinkling.

Inhibitory Effects of 4'-Demethylnobiletin, a Metabolite of Nobiletin, on 12-O-Tetradecanoylphorbol-13-acetate (TPA)-Induced Inflammation in Mouse Ears

Nobiletin (NOB) is major citrus flavonoid with many health-promoting benefits. We reported previously that 4'-demethylnobiletin (4DN), a major metabolite of NOB, significantly inhibited lipopolysaccharide (LPS)-stimulated inflammation in RAW 264.7 macrophages. In this study, we further studied the anti-inflammatory effects of 4DN in TPA-induced skin inflammation in mice. We demonstrated that topical application of 4DN decreased TPA-induced ear edema by >88 ± 4.77% in mice. This inhibitory effect was associated with inhibition on TPA-induced up-regulation of pro-inflammatory cytokines IL-1β, IL-6, and TNF-α. Immunoblotting results showed that 4DN resulted in profound effects on multiple proteins related with inflammation and carcinogenesis. 4DN significantly decreased the expression levels of iNOS, COX-2, and MMP-9, suppressed phosphorylation of PI3K/Akt and ERK, and increased the levels of HO-1 and NQO1 in TPA-treated mice. Overall, the results demonstrated that 4DN had strong anti-inflammatory effects in vivo, which provided a scientific basis for using NOB to inhibit inflammation-driven diseases.

Management of Chronic Hand Eczema

Management of hand eczema is complex because of the broad range of different pathogeneses, courses, and prognoses. Furthermore, the efficacy of most available treatments is not well established and the more severe forms can have a major impact on the patient's quality of life. Patient education, preventive measures, and the use of emollients are the mainstays in the management of hand eczema. High-potency topical corticosteroids are the treatment of choice, with calcineurin inhibitors used for maintenance. Phototherapy or systemic treatments are indicated in patients who do not respond to topical treatments. Switching from topical treatments should not be delayed to avoid sensitizations, time off work, and a negative impact on quality of life. Alitretinoin is the only oral treatment approved for use in chronic hand eczema.

Efficacy of the saponin component of Impatiens capensis Meerb.in preventing urushiol-induced contact dermatitis

ETHNOPHARMACOLOGICAL RELEVANCE

Many different tribes of American Indians used jewelweed, Impatiens capensis Meerb, as a plant mash to reduce development of poison ivy dermatitis. Saponins are a natural soapy constituent found within plants. A 2012 study suggested that saponins may be present in jewelweed which could be responsible for its efficacy in preventing rash development following contact with Toxicodendron radicans (L.) Kuntze (poison ivy). This study validated this hypothesis and demonstrated additional biological activity of the jewelweed saponin containing extract.

MATERIALS AND METHODS

Fresh I. capensis leaves were extracted with methanol and further partitioned between ethyl acetate and water, with a final separation between water and n-butanol, to obtain a saponin containing extract. The presence of saponins in the extract was demonstrated by the observation of foaming and using a vanillin colorimetric assay for total saponins. Efficacy of the saponin containing extracts in rash reduction was tested by brushing poison ivy (PI) onto the forearms of volunteers (N=23) in six locations and treating these PI exposed areas with distilled water (control), saponin containing extracts, fresh plant mashes, and soaps made with and without plant extracts. Saponin containing extracts were further tested for biological activity against both gram negative and gram positive bacteria and against cancer cell lines A-375, HT-29, and MCF-7. Additionally, because saponins have been shown to have a stimulatory effect in cardiac muscle 2 µl saponin extract was applied superficially to black worms, Lumbriculus variegatus (N=5).

RESULTS, AND CONCLUSIONS

Both saponin containing extracts and all soaps tested were effective in reducing poison ivy dermatitis; thus, saponin content correlates with PI rash prevention. No apparent antibiosis was observed against any bacteria tested; however, dose response cytotoxicity was documented against MCF-7 breast cancer cells and cytostatic activity was seen against the HT-29 colon cancer cell lines. Lumbriculus variegatus exhibited a 138% increase in heart rate over baseline rate five minutes post treatment implying a possible positive chronotropic effect.

[Barrier creams in prevention of hand dermatoses]

Contact dermatitis is a common skin disease in the workplace and at home. Due to the high incidence of skin diseases the European Union countries have taken the activity to reduce or minimize this problem by the promotion of skin protection program, based on the application of skin protection measures - barrier creams and moisturizers. Definitions, reasons, mechanism of action and duration, application of methods, as well as the efficacy of using skin protection products in different workplaces are extensively reviewed in this article. Correctly matched barrier preparations protect against harmful factors and irritants, facilitating at the same time hand washing at the end of the working day, and together with the use of suitable non-irritating detergents and skin care products are important elements contributing to the prevention of occupational skin diseases. They shouldn't be used as a primary protection against high-risk substances. Numerous creams declared as the skin protection measures are on the market, so a careful selection of appropriate effective skin protecting barrier cream for the specific situations/environments is recommended.

[Hymenoptera venom allergy. Analysis of double sensitization to wasp and bee venom in own material--diagnosis and classification for immunotherapy]

According to scientific societies guidelines the indication for venom immunotherapy is based on the clinical history of the patient. Diagnostic tests, like skin prick test or specific IgE serum estimation are conduct to prove IgE dependent mechanism of allergy and insect identification. Recent guidelines indicates for group of patients with severe systemic reactions as a candidates for diagnostic testing and in consequence for immunotherapy. In some countries diagnostic tests are also performed in patient who have a history of large local reactions, if they are considered as a candidates for immunotherapy. Double sensitization in cases of patients unable to identify the culprit insect is a diagnostic and therapeutic problem. In our group of patients (n = 113) we confirmed the double sensitization in 30% cases. The addition of a major allergen labeling reduced the number of people actually double-sensitized to 8.84%. It was observed that in patients who are not able to identify insect double sensitization phenomenon is particularly frequent as much as 45.5% and in the determination of the major allergens in 18.2%. Such patients needed detailed diagnosis and in many cases the use of two vaccines to conduct immunotherapy.

Attenuated Bordetella pertussis BPZE1 protects against allergic airway inflammation and contact dermatitis in mouse models

BACKGROUND

We previously reported that prior nasal administration of highly attenuated Bordetella pertussis BPZE1 provides effective and sustained protection against lethal challenge with influenza A viruses. The protective effect was mediated by suppressing the production of major pro-inflammatory mediators. To further explore the anti-inflammatory properties of BPZE1, we investigated the effect of BPZE1 nasal pretreatment on two mouse models of allergic disease, allergic airway inflammation, and contact hypersensitivity (CHS).

METHODS

Allergic reactions were induced in mice nasally pretreated with live attenuated BPZE1 bacteria using the ovalbumin (OVA)-induced allergic airway inflammation and dinitrochlorobenzene (DNCB)-induced CHS models.

RESULTS

Prior BPZE1 nasal treatment suppressed OVA-induced lung inflammation and inflammatory cell recruitment and significantly reduced IgE levels and cytokine production. Similarly, BPZE1 nasal pretreatment markedly inhibited ear swelling, skin inflammation, and production of pro-inflammatory cytokines in the DNCB-induced CHS model. For both models, we showed that BPZE1 pretreatment does not affect the sensitization phase. Upon challenge, BPZE1 pretreatment selectively reduced the level of cytokines whose production is increased and did not affect the basal level of other cytokines. Together, our observations suggest that BPZE1 pretreatment specifically targets those cytokine-producing effector cells that are recruited and involved in the inflammatory reaction.

CONCLUSION

Our study demonstrates the broad anti-inflammatory properties of the attenuated B. pertussis BPZE1 vaccine candidate and supports its development as a promising agent to prevent and/or treat allergic diseases.

Nanoparticles reduce nickel allergy by capturing metal ions

Approximately 10% of the population in the USA suffer from nickel allergy, and many are unable to wear jewellery or handle coins and other objects that contain nickel. Many agents have been developed to reduce the penetration of nickel through skin, but few formulations are safe and effective. Here, we show that applying a thin layer of glycerine emollient containing nanoparticles of either calcium carbonate or calcium phosphate on an isolated piece of pig skin (in vitro) and on the skin of mice (in vivo) prevents the penetration of nickel ions into the skin. The nanoparticles capture nickel ions by cation exchange, and remain on the surface of the skin, allowing them to be removed by simple washing with water. Approximately 11-fold fewer nanoparticles by mass are required to achieve the same efficacy as the chelating agent ethylenediamine tetraacetic acid. Using nanoparticles with diameters smaller than 500 nm in topical creams may be an effective way to limit the exposure to metal ions that can cause skin irritation.

1α,25-Dihydroxyvitamin D3 and all-trans retinoic acid synergistically inhibit the differentiation and expansion of Th17 cells

1α,25-Dihydroxyvitamin D(3) (1,25D3), the active form of vitamin D(3), is an immunoregulatory hormone with beneficial effects on Th1 cell-mediated inflammatory diseases. Although IL-17-producing CD4(+) T helper (Th17) cells have been recently identified as novel effector cells, the immunomodulating effects of 1,25D3 on Th17 cells have not been well defined. We confirmed here that 1,25D3 inhibited the generation of Th17 cells in vitro. Interestingly, 1,25D3 synergistically suppressed the generation of Th17 cells by the combination with all-trans retinoic acid (ATRA). 1,25D3 and ATRA suppressed the development of allergen-induced contact hypersensitivity (CHS) in a mouse ear swelling model. In addition, we found that 1,25D3 and ATRA significantly inhibited the development of human Th17 cells from both naïve and memory human CD4(+) T cells. 1,25D3 and ATRA effectively suppressed mRNA expressions of IL-1R1, IL-21R, IL-23R, RORC, and AHR in human T cells. ATRA further suppressed IL-6R, whereas 1,25D3 did not. Finally, we found that 1,25D3 and ATRA remarkably blocked IL-22 as well as IL-17 mRNA expression in human memory CD4(+) T cells. Thus, we initially reveal that 1,25D3 and ATRA have synergistic effects on the generation of Th17 cells, suggesting that the combination with ATRA would provide a promising novel therapy for Th17 cell-related immune diseases including skin inflammation.

Concise guidance: diagnosis, management and prevention of occupational contact dermatitis

Occupation is an important risk factor for contact dermatitis that presents in adulthood. Occupational contact dermatitis often has significant adverse effects on quality of life and the long-term prognosis is poor unless workplace exposures are addressed. The condition often presents to general practitioners, physicians or dermatologists who will be responsible for facilitating management of the workplace issues in the event that an occupational health service is not accessible. This concise guidance summarises three sets of guidance from the Occupational Health Clinical Effectiveness Unit, the British Occupational Health Research Foundation and the British Association of Dermatologists respectively. It is aimed at physicians in primary and secondary care, covering the clinical aspects of case management but also drawing attention to the important actions they should take to address the workplace issues, either in liaison with an occupational health provider or in the absence of occupational health input.

Anti-inflammatory effect of crude extract and isolated compounds from Baccharis illinita DC in acute skin inflammation

ETHNOPHARMACOLOGYCAL RELEVANCE: The tea from the leaves of Baccharis illinita DC (Asteraceae family) is commonly used by the population as anti-inflammatory (including topically), protective gastric and anti-infectious. However, no studies have been done with this species to confirm its topical anti-inflammatory action.

AIM

This study evaluated he topical effects of crude extract of leaves (CE) and its active constituents in 12-O-tetradecanoylphorbol acetate (TPA)-induced ear oedema.

METHODOLOGY

CE and compounds effects were tested in commonly used models of TPA-, arachidonic acid (AA)- and capsaicin-ear oedema. Polymorphonuclear (PMN) cell migration was evaluated by mieloperoxidase and analyzed histologically.

RESULTS

CE (0.1-1 mg/ear) caused a dose-related inhibition of TPA-induced ear oedema and PMN influx similarly to that produced by topical application of the steroidal anti-inflammatory drug dexamethasone. The active constituents of the AcOEt fraction kaurenoic acid, alpha-spinasterol, oleanolic acid and baurenol also inhibited TPA-induced ear edema. Histological analysis of the ear of CE-treated animals confirmed the reduction of edema and of PMN infiltration. Both CE and the nosteroidal anti-inflammatory drug indomethacin inhibited the AA-induced ear oedema, but did not change capsaicin-induced oedema.

CONCLUSION

These results indicate that the CE and the active constituents have a topical anti-inflammatory effect and the possible mechanisms for the pharmacological effects are discussed.

Inhibitory effect of magnolol on TPA-induced skin inflammation and tumor promotion in mice

Magnolol has been reported to have an anti-inflammatory and antitumor effect in vitro and in vivo. Herein, we report the investigation of the inhibitory effects of magnolol on 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) in mouse skin. We found that the topical application of magnolol effectively inhibited the transcriptional activation of iNOS and COX-2 mRNA and proteins in mouse skin stimulated by TPA. Pretreatment with magnolol resulted in the reduction of TPA-induced nuclear translocation of the nuclear factor-kappaB (NFkappaB) subunit and DNA binding by blocking the phosphorylation of IkappaBalpha and p65 and subsequent degradation of IkappaBalpha. In addition, magnolol can suppress TPA-induced activation of extracellular signal-regulated kinase (ERK)1/2, p38 mitogen-activated protein kinase (MAPK), and phosphatidylinositol 3-kinase (PI3K)/Akt, which are upstream of NFkappaB. Moreover, magnolol significantly inhibited 7,12-dimethylbene[a]anthracene (DMBA)/TPA-induced skin tumor formation by reducing the tumor multiplicity, tumor incidence, and tumor size of papillomas at 20 weeks. All these results revealed that magnolol is an effective antitumor agent and that its inhibitory effect is through the down-regulation of inflammatory iNOS and COX-2 gene expression in mouse skin, suggesting that magnolol is a novel functional agent capable of preventing inflammation-associated tumorigenesis.

Skin safety evaluation of laundry detergent products

The conduct of a scientifically sound safety assessment of new ingredients and finished products is essential prior to their introduction into the marketplace. Such assessments are based on a risk assessment paradigm established by the National Academy of Science (NAS, 1983) that consists of a four-step process: hazard identification, dose-response assessment, exposure assessment, and risk characterization. This risk assessment paradigm has been (1) used as a framework for estimating an adverse health risk posed by environmental chemicals, and (2) applied to systemic toxicological endpoints. The general principles of risk assessment may be applied to skin safety evaluation of consumer products, considering that dermal toxicity is also a threshold phenomenon. This study describes a risk assessment-based approach for skin safety evaluation of laundry detergent products.

[Methodology to forecast risk of toxic effects caused by contemporary household chemicals]

The article contains to forecast risk of toxic effects caused by contemporary household chemicals. The article contains data on evaluating potential risk of health disorders among individuals contacting synthetic detergents and cleansers. The authors summarized experience of Public Health Research center on toxicologic hygienic research of various household chemicals, conducted for safety certification of the end products household application.

Clinical safety evaluation of a novel barrier protection cream

Patients with contact dermatitis require both preventive and therapeutic interventions to minimize their burden of disease. The ideal product would support resolution of inflamed skin without the use of glucocorticoids while protecting undamaged skin against further contact with irritants and antigens. COR806.805 (Tetrix Cream) is a novel barrier cream formulated for use on both lesional and nonlesional skin. Three clinical trials were conducted to evaluate the safety of this new product by studying sensitization, cumulative irritation, and effect on healing; a combined total of 265 participants completed the studies (210, 45, and 10, respectively), with no serious adverse events considered to be related to the product. Six mild adverse events were considered related or potentially related. As tested, COR806.805 is neither sensitizing nor irritating when applied to intact or lesional skin. Testing indicates that COR806.805 does not inhibit healing of allergic contact dermatitis lesions.

Clinical efficacy evaluation of a novel barrier protection cream

COR806.805 (Tetrix Cream) is a new barrier cream formulated using a unique patented technology. As a water-in-oil emulsion, COR806.805 has a water-resistant outer surface and water-soluble inner surface. Clinical studies have demonstrated the safety of COR806.805 in healthy adults with respect to sensitization, irritation, and effect on the healing of existing skin lesions. We report the results of trials undertaken to explore the substantivity and barrier protection properties of this new product when applied to clinically normal skin, as well as the beneficial effects when applied to inflamed skin, including skin affected by eczema. The results indicate that the cream establishes a barrier against common irritants, with persistence over 6 hours. The product appears effective and well-tolerated as a barrier and also may provide benefit in managing the itching and burning associated with contact dermatitis.

Inhibition of skin inflammation and atopic dermatitis by topical application of a novel ceramide derivative, K112PC-5, in mice

PC-9S (N-Ethanol-2-mirystyl-3-oxo-stearamide) is a synthetic ceramide and has been known to be effective in atopic and psoriatic patients. K112PC-5 (2-Acetyl-N-(1,3-dihydroxyisopropyl)-tetradecanamide) is a novel ceramide derivative of PC-9S. In the present study, we examined the effect of K112PC-5 on macrophage and T lymphocyte function in primary macrophages and splenocytes, respectively, as well as the effect of topical application of K112PC-5 on skin inflammation and atopic dermatitis (AD) in mouse models. K112PC-5 inhibited lipopolysaccharide-induced nitrite generation in mouse peritoneal macrophages in a dose-dependent manner. However, K112PC-5 did not affect concanavalin A-induced proliferation, interleukin (IL)-2 secretion and IL-4 secretion in mouse splenocytes. In addition, K112PC-5 significantly suppressed the increase in phorbol ester-induced ear thickness in BALB/c mice. Further study demonstrated that topical application of K112PC-5 also inhibited AD induced by extracts of dust mites, Dermatophagoides pteronyssinus and Dermatophagoides farinae, in NC/Nga mice. Taken together, these results showed that K112PC-5 exerted an anti-inflammatory effect both in vitro and in vivo and proved to be beneficial in an animal model of AD. Our results suggest that K112PC-5 might be beneficial as a topical agent for the treatment of AD.

CD83 expression in CD4+ T cells modulates inflammation and autoimmunity

The transmembrane protein CD83 has been initially described as a maturation marker for dendritic cells. Moreover, there is increasing evidence that CD83 also regulates B cell function, thymic T cell maturation, and peripheral T cell activation. Herein, we show that CD83 expression confers immunosuppressive function to CD4(+) T cells. CD83 mRNA is differentially expressed in naturally occurring CD4(+)CD25(+) regulatory T cells, and upon activation these cells rapidly express large amounts of surface CD83. Transduction of naive CD4(+)CD25(-) T cells with CD83 encoding retroviruses induces a regulatory phenotype in vitro, which is accompanied by the induction of Foxp3. Functional analysis of CD83-transduced T cells in vivo demonstrates that these CD83(+)Foxp3(+) T cells are able to interfere with the effector phase of severe contact hypersensitivity reaction of the skin. Moreover, adoptive transfer of these cells prevents the paralysis associated with experimental autoimmune encephalomyelitis, suppresses proinflammatory cytokines IFN-gamma and IL-17, and increases antiinflammatory IL-10 in recipient mice. Taken together, our data provide the first evidence that CD83 expression can contribute to the immunosuppressive function of CD4(+) T cells in vivo.

Experiences with implementation of evidence-based prevention programs to prevent occupational skin diseases in different occupations

Occupational skin diseases are among the most frequently recognized occupational diseases in many industrialized countries. This paper describes and review experiences with implementation of interventions to prevent occupational skin diseases in different occupational settings representing the food processing industry and a hospital. The study populations were gut cleaners with all participants being exposed to wet work, cheese dairies and a hospital where all employees were included. The effect of implementation of evidence-based prevention programs were tested by questionnaire surveys on baseline and follow-up. A significant reduction in eczema at hands or forearms was observed among gut cleaners. At cheese dairies the eczema frequencies were low except for a comparison dairy where significant changes were seen. At the hospital a non significant reduction in hand eczema was observed. Changes related to use of protective measures and knowledge on prevention of occupational skin diseases were observed. A process evaluation carried out at the gut cleaning departments showed association between the eczema frequency at follow-up, activities related to prevention and implementation of an occupational health management system. In addition to documenting the scientific background for evidence-based prevention programs to prevent occupational skin diseases in different occupations, both the study population and the study design should be considered carefully when testing the implementation of workplace interventions. These aspects may influence the outcome in different directions and either facilitate or hamper the possibilities to provide scientific documentation of the effect of the intervention tested.

[Work-related diseases of the skin]

Work-related diseases of the skin are aetiologically completely different diseases. The common denominator is that they are all triggered by occupational activity. Allergic and cumulative irritant contact eczema occur the most frequently. Early reporting of occupational dermatosis to the accident insurance carrier should first and foremost lead to adequate preventive measures at the workplace. Early recognition, systematic therapy and rapidly implemented prevention should enable the affected person to continue to work in his or her occupation. To implement appropriate preventive measures, the collaboration of the family physician, dermatologists, company doctor and accident insurance carrier is desired.