Faecal enzymes: in vivo human skin irritation.
Digestive enzymes in faeces have been reported to possess skin irritation potential. The present study was designed to investigate the in vivo irritant potentials of faecal concentrations of proteolytic and lipolytic digestive enzymes in bile salt mixtures. In a 21-day cumulative irritation assay, clinical evaluation and noninvasive bioengineering techniques were used. 5 days occlusive exposure to phosphate buffer (pH = 8) caused no visual skin damage but reflectance spectroscopy demonstrated significant vasodilation (p < 0.01) and increases in transepidermal water loss (TEWL) and skin pH were also observed (p < 0.01). These increases were still present at days 12 and 19. Occlusive exposure to physiologic concentrations of faecal enzymes resulted in significant visual and objective scores at day 5, 12, and 19, with increased readings as a function of exposure time (p < 0.01). The enzyme mixture containing lipase caused delayed onset of skin erythema and epidermal barrier disruption compared to elastase and chymotrypsin containing solutions. Prolonged occlusive exposure to digestive enzymes in faecal concentrations caused severe skin erythema and epidermal barrier disruption in a human model, suggesting a possible etiologic role of digestive enzymes in perianal, circumstomal or diaper dermatitis.
Andersen
P H
PH
Department of Dermatology, University of California, School of Medicine, San Francisco 94143-0989.
Bucher
A P
AP
Saeed
I
I
Lee
P C
PC
Davis
J A
JA
Maibach
H I
HI
D000328:Adult; D002635:Chenodeoxycholic Acid / Q000494:pharmacology; D019826:Cholic Acid; D002793:Cholic Acids / Q000494:pharmacology; D002918:Chymotrypsin / Q000494:pharmacology; D003840:Deoxycholic Acid / Q000494:pharmacology; D017453:Dermatitis, Irritant / Q000209:etiology*; D004890:Erythema / Q000209:etiology; D005243:Feces / Q000201:enzymology*; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007509:Irritants / Q000494:pharmacology*; D008049:Lipase / Q000494:pharmacology; D008095:Lithocholic Acid / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D010196:Pancreatic Elastase / Q000494:pharmacology; D012867:Skin / Q000187:drug effects; D012879:Skin Physiological Phenomena; D012967:Sodium Dodecyl Sulfate / Q000494:pharmacology; D014357:Trypsin / Q000494:pharmacology; D014870:Water Loss, Insensible / Q000187:drug effects
D002793:Cholic Acids; D007509:Irritants; D003840:Deoxycholic Acid; D002635:Chenodeoxycholic Acid; D012967:Sodium Dodecyl Sulfate; D008095:Lithocholic Acid; D008049:Lipase; D002918:Chymotrypsin; D010196:Pancreatic Elastase; D014357:Trypsin; D019826:Cholic Acid