Dermatologic Effects and Management of Urine and Feces on Infant and Adult Skin.

The effect of urine and feces on the skin is a contributing factor to the development of incontinent and diaper dermatitis. The objective of this research was to evaluate skin effects of a given urine or fecal sample on the donor child and/or an adult caregiver, both of whom would be exposed to the biological material in course of daily life. Methods: Urine was evaluated under a variety of experimental skin conditions: normal (N), compromised by tape stripping (C), hydrated by prolonged exposure to water via occlusive patch (H), and hydrated/compromised (H/C). After pre-treatment, sites were patched (3 times of 24-h each) with 0.5 ml infant urine, saline (negative control) or 0.3% sodium lauryl sulfate (SLS, positive control). Fecal material was evaluated using a 4-h patch followed by tape stripping of selected sites. Results: In the urine study, a single 24-h patch produced a significant elevation of pH compared to both the negative (saline) and positive (sodium lauryl sulfate) controls for all experimental skin conditions. Erythema produced by urine was intermediate between the negative and positive controls, and significantly different from the negative control on the N and C skin test sites. All three materials produced an increase in hydration of the skin. The single 4-h patch of fecal material produced significant erythema, a significant elevation of pH, and a significant increase in TEWL. Recovery to pre-treatment levels was observed by the next day on sites that received no further treatment. However, on sites patched with fecal material, then further compromised by tape stripping, recovery to pre-treatment levels for erythema and TEWL were delayed. Conclusion: These studies indicate that urine appears to have an inherent low level irritant property when in continuous contact with skin for 24 to 48 hours. With relatively short exposures of 4 hours fecal material causes visible erythema, increases in pH and TEWL, and decreases in stratum corneum resilience to the subsequent insult of tape stripping. Results re-inforce the utility of modern diapers and incontinent products, utilizing superabsorbent materials, to effectively absorb wetness, keeping skin dryer and minimizing adverse skin effects.

The Behind the Knee (BTK) as an Innovative Test Model for Mechanical and Chemical Irritation, Lotion and Dye Transfer and Testing on Compromised Skin.

Aims: The aim of this manuscript is to present innovative applications of the BTK model that can potentially contribute additional aspects of safety evaluations for a broader range of products and materials intended for prolonged skin contact. Study Design and Methodology: The basic BTK protocol is one 6-h exposure per day for 4 days. Modification to the basic protocol were made for individual studies, as needed. Results: Studies using fabrics, tissues and films indicate the BTK may be well suited to evaluating these materials for skin compatibility. The BTK test discriminated between; different fabrics, drying methods of the same fabric, similar toilet tissue products, and two similar topsheet films used as coverings on the surface of a range of absorbent consumer products. The method was used successfully to measure the transfer of lotion, and lotion skin benefits from lotioned absorbent products. Conclusion: Studies demonstrate that the utility of the BTK goes beyond the original intent of evaluating the potential skin effects of feminine protection products. The ability to compare fabrics, tissues and films indicate the test model may be useful in the development broad range of absorbent consumer products and in textile development. The utility of the model in measuring the transfer of lotion and other materials from products to the skin surface has the potential to fill an important gap in the development of quantitative exposure assessments. Added endpoint measures, such as enhanced visual scoring and sensory effects further increase the ability to differentiate between very similar products without requiring other protocol modifications.

A Body Divided: Toward Reunification of the Paradigm.

Symptoms without obvious physical cause are commonly reported in medical practice; when chronic, they can have a significant influence on patients' well-being. When traditional medicine is unable to provide relief, sufferers of such conditions often turn to alternative therapies. Western medicine has historically viewed the body through a silo model, i.e, a whole consisting of disparate body systems with well-defined boundaries and little relevant interaction. This model ignores the myriad of interactive functions that each system must require and hinders understanding of syndromes for which etiology is not confined to one organ system, particularly those with a strong psychosocial component. In addition, this model is increasingly shown to be antiquated: recent evidence of Pavlovian conditioning of physiological processes (i.e., placebo and nocebo affects, immune system conditioning), physiological distinctions between multiple personalities, and the pervasive effects of psychosocial stress on every body system (down to the level of the genome) demand a new paradigm. As our appreciation expands of the innumerable interactions between body systems as well as those between all body systems and the mind, the human body is revealed to be a complex web of neurological, immunologic and endocrine interactions that in turn modulate a fluid epigenetic base. Firmly planted in the rationalistic viewpoint that is the foundation of Western medicine, but inclusive of the more wholistic (mind and body) view of Eastern medicine, a nexus model which views the body as the series of multi-connected, interacting physiological webs is essential to continued progress in medicine.