title: Stratum corneum cytokines, structural proteins, and transepidermal water loss: effect of hand hygiene.
abstract: OBJECTIVE
  There are few reports on the cytokine response to high frequency hand hygiene among health care workers (HCWs) in an occupational setting. We have observed significant skin barrier compromise consistent with chronic irritant contact dermatitis in HCWs. We hypothesized that repetitive hand hygiene would activate the epidermal inflammatory cascade and lead to changes in structural proteins and cytokines.
  
  
  METHODS
  Keratin 6, keratin 1, 10, 11, involucrin, IL1alpha, TNFalpha, IL8, IL1RA, and IL10 were analyzed from the SC using bead-based arrays. Knuckle and dorsum samples were evaluated for HCWs (n=23) before and after repetitive hand hygiene and compared with those of age-matched non-wet workers (n=23) without hand skin irritation. Erythema, dryness, and barrier integrity were measured.
  
  
  RESULTS
  Transepidermal water loss (TEWL) was higher for HCWs but unchanged with exposure. IL1alpha and TNFalpha were highest in control volar forearm. IL1alpha, TNFalpha, and IL8 were significantly lower in HCWs than controls despite higher erythema, dryness, and TEWL. Decreases in keratin 1, 10, 11, increases in keratin 6, and reduction in IL1alpha, TNFalpha, and IL8 were seen after hand hygiene.
  
  
  CONCLUSIONS
  This preliminary study showed significantly lower SC biomarker levels in HCW compared with controls and regional differences between the hand and forearm. Exposure to repetitive hand hygiene results in substantial chronic skin irritation without time for barrier recovery between work periods. The impact on SC structural proteins and cytokines has many commonalities with chronic inflammation, although mechanistic questions remain.
authors.affiliation: The Skin Sciences Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH45229, USA. Marty.Visscher@cchmc.org
authors.forename: Marty O
authors.initials: MO
authors.lastname: Visscher
authors.forename: Dina
authors.initials: D
authors.lastname: Said
authors.forename: Randy
authors.initials: R
authors.lastname: Wickett
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D001834:Body Water / Q000378:metabolism*; D016207:Cytokines / Q000378:metabolism*; D017453:Dermatitis, Irritant / Q000276:immunology / Q000378:metabolism* / Q000473:pathology; D004817:Epidermis / Q000276:immunology / Q000378:metabolism* / Q000473:pathology; D005260:Female; D006235:Hand Disinfection; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein / Q000378:metabolism; D016753:Interleukin-10 / Q000378:metabolism; D053582:Interleukin-1alpha / Q000378:metabolism; D016209:Interleukin-8 / Q000378:metabolism; D053556:Keratin-1 / Q000378:metabolism*; D053550:Keratin-10 / Q000378:metabolism; D008297:Male; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D014870:Water Loss, Insensible / Q000502:physiology
chemical_list: D015415:Biomarkers; D016207:Cytokines; C508609:IL10 protein, human; C507763:IL1RN protein, human; D053590:Interleukin 1 Receptor Antagonist Protein; D053582:Interleukin-1alpha; D016209:Interleukin-8; C491616:KRT1 protein, human; C507493:KRT10 protein, human; D053556:Keratin-1; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D053550:Keratin-10