A double-blind, randomized study to assess the effectiveness of different moisturizers in preventing dermatitis induced by hand washing to simulate healthcare use.
BACKGROUND
Healthcare-associated infection is an important worldwide problem that could be reduced by better hand hygiene practice. However, irritant contact dermatitis of the hands as a result of repeated hand washing is a potential complication that may be preventable by the regular use of an emollient.


OBJECTIVE
To assess the effect of moisturizer application after repeated hand washing (15 times daily) vs. soap alone.


METHODS
In a double-blind, randomized study, the effect of five different moisturizers on skin barrier function was determined by assessment after repeated hand washing over a 2-week period in healthy adult volunteers. Assessments of transepidermal water loss (TEWL), epidermal hydration and a visual assessment using the Hand Eczema Severity Index (HECSI) were made at days 0, 7 and 14.


RESULTS
In total, 132 patients were enrolled into the study. A statistically significant worsening of the clinical condition of the skin as measured by HECSI was seen from baseline to day 14 (P = 0.003) in those subjects repeatedly washing their hands with soap without subsequent application of moisturizer. No change was seen in the groups using moisturizer. Subclinical assessment of epidermal hydration as a measure of skin barrier function showed significant increases from baseline to day 14 after the use of three of the five moisturizing products (P = 0.041, 0.001 and 0.009). Three of the five moisturizers tested led to a statistically significant decrease in TEWL at day 7 of repeated hand washing. This effect was sustained for one moisturizing product at day 14 of hand washing (P = 0.044).


CONCLUSIONS
These results support the view that the regular application of moisturizers to normal skin offers a protective effect against repeated exposure to irritants, with no evidence of a reduction in barrier efficiency allowing the easier permeation of irritant substances into the skin as has been suggested by other studies. Regular use of emollient in the healthcare environment may prevent the development of dermatitis.
Williams
C
C
Skin Research Centre, University of Leeds, Leeds LS1 3EX, UK. tinawilliams@doctors.org.uk
Wilkinson
S M
SM
McShane
P
P
Lewis
J
J
Pennington
D
D
Pierce
S
S
Fernandez
C
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D001834:Body Water / Q000378:metabolism; D009783:Dermatitis, Occupational / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D004311:Double-Blind Method; D004643:Emollients / Q000494:pharmacology / Q000627:therapeutic use*; D004817:Epidermis / Q000378:metabolism; D006229:Hand Dermatoses / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006235:Hand Disinfection; D006801:Humans; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014870:Water Loss, Insensible / Q000187:drug effects; D055815:Young Adult
D004643:Emollients