title: Artificial disruption of skin barrier prior to irritant patch testing does not improve test design.
abstract: BACKGROUND
  Irritant patch testing is often performed as a 24- or 48-h occlusive patch test with low concentrations of sodium lauryl sulphate (SLS).
  
  
  OBJECTIVE
  The aim of this study was to investigate potential ways to shorten this test procedure and obtain precise test results.
  
  
  METHODS
  Thirty-six healthy volunteers underwent irritant patch testing with different pretreatments (PT) of the test fields. Occlusive test chambers were applied on the upper back with SLS 0.5%, 1%, 2% and 5% in large Finn Chambers(R). The patches were removed after 4 and 24 h, respectively, depending on the concentration used. Test fields were pretreated as follows: PT 0, field without any PT (control); PT 1, prick with lancet; PT 2, prick with test stamp; PT 3, scratch with lancet; PT 4, incision with standardized incision instrument (0.1-0.2 mm depth). Skin reactions were evaluated by transepidermal water loss (TEWL), skin erythema and skin hydration and as well by a visual score (VS) at 4, 24 and 72 h.
  
  
  RESULTS
  Our data show an obvious distinction between PT 0-2 and PT 3-4 at all measurement methods. The average TEWL values with PT 3-4 were higher than those with PT 0-2, especially on the 4-h course. This distinction may derive from the shape and size of the skin impairment achieved by PT 3-4, leading to a mechanical barrier disruption. However, SLS may infiltrate directly into deeper skin layers supported by capillarity. Consequently, no or little penetration through the epidermis and interaction with its structures occurs, which is responsible for irritant skin reactions. The SLS dose in the upper skin layers is therefore lower at these PTs. The lower remaining dose of SLS also explains this distinction, especially for the VS. Additionally, there are presumed reactions in deeper layers of the epidermis and dermis at PT 3-4.
  
  
  CONCLUSIONS
  In summary, all data suggest a different reaction pattern from the classical irritant response. Therefore, application without any PT seems to be best suited for irritancy skin testing, especially for visual assessment. PTs prior to irritant patch testing have been shown to be unjustifiable.
authors.affiliation: Department of Dermatology, Philipp-University of Marburg, Deutschhausstr. 9, D-35033 Marburg, Germany.
authors.forename: K L
authors.initials: KL
authors.lastname: Gebhard
authors.forename: I
authors.initials: I
authors.lastname: Effendy
authors.forename: H
authors.initials: H
authors.lastname: Löffler
mesh_terms: D000328:Adult; D001834:Body Water / Q000378:metabolism; D017453:Dermatitis, Irritant / Q000175:diagnosis* / Q000209:etiology; D016503:Drug Delivery Systems; D004890:Erythema / Q000139:chemically induced; D005260:Female; D006801:Humans; D007509:Irritants / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010328:Patch Tests / Q000379:methods*; D015203:Reproducibility of Results; D023422:Skin Irritancy Tests / Q000379:methods*; D012967:Sodium Dodecyl Sulfate / Q000008:administration & dosage; D013997:Time Factors; D014870:Water Loss, Insensible / Q000187:drug effects
chemical_list: D007509:Irritants; D012967:Sodium Dodecyl Sulfate