A Randomized, Controlled Clinical Trial of a Dermocosmetic Containing Vichy Volcanic Mineralizing Water and Probiotic Fractions in Subjects with Rosacea Associated with Erythema and Sensitive Skin and Wearing Protective Masks.

Purpose: Rosacea is a common facial dermatosis, with flares induced by exposome factors. M89PF containing Vichy mineralizing water, probiotic fractions, hyaluronic acid, niacinamide and tocopherol repairs the skin barrier and reinforces skin defences against exposome factors. This study assessed the benefit of M89PF in subjects with rosacea associated with erythema and sensitive skin during the Covid-19 pandemic using protective face masks. Methods: M89PF was compared to usual skin care in a randomized, split-face study, for 30 days in subjects with rosacea associated with erythema and sensitive skin. Clinical evaluations included erythema, desquamation, skin tightness, dryness, burning sensation, itching, stinging, stinging test, and local tolerability. Instrument evaluations included erythema, skin hydration and TEWL. Subject satisfaction was also assessed. Results: Erythema significantly improved with M89PF at both time points (p<0.01 at D15, and p<0.001 at D30). Skin sensitivity assessed by the skin stinging test improved significantly (p<0.01) with M89PF at D30, compared to baseline and usual skin care. Skin erythema, tightness, dryness, hydration and TEWL significantly improved (p≤0.05) with M89PF at D15 and D30, versus baseline and the untreated side. Subjects were highly satisfied with M89PF at D15 and D30. Tolerance was very good in all subjects. Conclusion: In subjects with rosacea, M89PF significantly reduces erythema, skin tightness, dryness and TEWL, and improves skin hydration and skin sensitivity, even when using protective masks. M89PF is well tolerated and received high satisfaction ratings. ClinicalTrialsgov No: NCT05562661.

Effects of one year of daily face mask wearing on the skin during the coronavirus disease 2019 pandemic.

BACKGROUND: As coronavirus disease 2019 (COVID-19) continues, the long-term daily use of masks is increasing. A full year includes the four seasons of spring, summer, autumn, and winter. Skin may have been affected by the seasons and further affected by the use of masks. In a previous study, we confirmed the short-term and 6-month effects of wearing face masks. In this study, we investigated how certain characteristics of the skin change when wearing a mask for 1 year. Furthermore, we compared skin covered by the mask (mask-skin zone) to skin that was not covered. MATERIALS AND METHODS: The participants were 18 healthy adults (8 men; 10 women) who were asked to wear masks in their daily lives from June 2020 to June 2021. During this period, participants' skin characteristics, such as trans-epidermal water loss, skin hydration, skin elasticity, skin keratin amount, skin pore area, skin temperature, skin redness, and skin color, were measured five times. RESULTS: Trans-epidermal water loss, skin keratin amount, skin pore area, skin color, and skin elasticity changed significantly during the year. Furthermore, trans-epidermal water loss, skin hydration, skin keratin amount, skin pore area, and skin color were significantly different between the mask-wearing and non-mask-wearing areas of the face. CONCLUSION: The skin characteristics of the mask-skin zone can be affected by long-term wearing of a face mask under lifestyle and environmental conditions. During the COVID-19 pandemic, skin care for the mask-skin zone is also necessary for people who do not wear masks on a daily basis.

Local Response and Barrier Recovery in Elderly Skin Following the Application of High-Density Microarray Patches.

The high-density microneedle array patch (HD-MAP) is a promising alternative vaccine delivery system device with broad application in disease, including SARS-CoV-2. Skin reactivity to HD-MAP applications has been extensively studied in young individuals, but not in the >65 years population, a risk group often requiring higher dose vaccines to produce protective immune responses. The primary aims of the present study were to characterise local inflammatory responses and barrier recovery to HD-MAPs in elderly skin. In twelve volunteers aged 69-84 years, HD-MAPs were applied to the forearm and deltoid regions. Measurements of transepidermal water loss (TEWL), dielectric permittivity and erythema were performed before and after HD-MAP application at t = 10 min, 30 min, 48 h, and 7 days. At all sites, TEWL (barrier damage), dielectric permittivity (superficial water);, and erythema measurements rapidly increased after HD-MAP application. After 7 days, the mean measures had recovered toward pre-application values. The fact that the degree and chronology of skin reactivity and recovery after HD-MAP was similar in elderly skin to that previously reported in younger adults suggests that the reactivity basis for physical immune enhancement observed in younger adults will also be achievable in the older population.

Effects of skin washing frequency on the epidermal barrier function and inflammatory processes of the epidermis: An experimental study.

BACKGROUND: Increased hand hygiene measures during the COVID-19 pandemic have led to an increased quantum of hand eczema (HE). OBJECTIVES: To examine the effects of varying washing frequencies using current mild cleansing agents-alongside with the effect of a rehydrating cream-on the epidermal barrier function and inflammatory processes of the stratum corneum(SC). METHODS: Standardized skin washings on the volar aspects of the lower arms of skin-healthy volunteers were performed using the automated cleansing device either 5 or 11 times within 4 h for 60 s each with a standard cleanser, a lipid-containing syndet, or a lipid-containing syndet followed by one-time application of a rehydrating cream. Skin bioengineering parameters (transepidermal water loss, SC hydration, erythema, and SC pH) and biochemical/immunological parameters (interleukin-1α, interleukin-1α receptor antagonist and natural moisturizing factor) of SCsamples collected by tape stripping were assessed. RESULTS: All applied washing procedures provided comparable, mild effects on the epidermal barrier function and skin inflammation. CONCLUSION: Occupational skin cleansers seem to have improved regarding skin barrier damaging effects. To further corroborate this, a study design, modified on the basis of our findings, applying longer washing periods for consecutive days seems desirable.

Skin barrier function in nursing apprentices during the coronavirus disease 2019 (COVID-19) pandemic.

BACKGROUND: Studies investigating simultaneous influence of personal and work-related factors on skin health during the coronavirus disease 2019 (COVID-19) pandemic are missing. OBJECTIVES: To investigate the associations of skin hazards relevant for nursing apprentices with parameters of skin barrier function. METHODS: A total of 238 nursing apprentices attending the final year of education (median age 19 years) from vocational schools in Zagreb, Croatia, were enrolled in this study. We administered a questionnaire based on the Nordic Occupational Skin Questionnaire to the nursing apprentices, performed clinical examination of skin on the hands, and evaluated transepidermal water loss (TEWL) and stratum corneum (SC) pH on the dorsum of the hand. RESULTS: Around half of nursing apprentices had compromised hand skin barrier function, as indicated by TEWL values >25 g/m2 /h (48%) and SC pH >5.5 (57%). Skin barrier was compromised in around 40% of nursing apprentices without clinically observed skin symptoms. Elevated SC pH was independent of ambient conditions associated with skin symptoms and female sex. CONCLUSIONS: Measurement of SC pH was shown to be less sensitive to field conditions than TEWL, and should be employed more in the field studies. Strengthening of skin health promotion in healthcare workers and apprentices is needed in pandemic conditions.

Risk factors for hand eczema in the general population of Saudi Arabia during the COVID-19 pandemic: An internet-based cross-sectional study.

BACKGROUND: Hand eczema (HE) is a common disorder that negatively impacts the quality of life. During the COVID-19 pandemic, several studies have shown an increase in HE in health care workers. However, data on the general population are lacking. OBJECTIVE: To assess the prevalence and risk factors of HE among the Saudi general population during the pandemic. METHODS: This cross-sectional study was conducted using an online questionnaire composed of 4 sections (participant characteristics, history of atopic disorders, hand hygiene methods, and HE symptoms). It was distributed on Twitter during the lockdown period, between August 2020 and September 2020. Descriptive, bivariate, and multivariable analyses were conducted using STATA v16. RESULTS: A total of 582 (52.6% women and 47.4% men) participants responded to the questionnaire. The 6-month prevalence of HE was 34%. In multivariable analysis, having a past history of eczema, rhinitis/conjunctivitis, using soaps for >5 times daily, using gloves daily, and using moisturizers were significantly associated with HE. Interestingly, using sanitizers for >5 times daily was not a statistically significant risk factor. LIMITATIONS: Due to its internet-based nature, the response rate cannot be accurately calculated. In addition, the response bias and the small sample size limit the generalizability of the results and prevent drawing broad conclusions and accurate measurement of prevalence. CONCLUSION: HE prevalence increased during the pandemic in the Saudi general population. Frequent use of soaps and gloves, but not sanitizers, increased HE risk.

Impact of Water Exposure and Temperature Changes on Skin Barrier Function.

The frequency of hand hygiene has increased due to the COVID-19 pandemic, but there is little evidence regarding the impact of water exposure and temperature on skin. The aim of this study is to evaluate the effect of water exposure and temperature on skin barrier function in healthy individuals. A prospective observational study was conducted. Temperature, pH, transepidermal water loss (TEWL), erythema and stratum corneum hydration (SCH) were measured objectively before and after hot- and cold-water exposure and TempTest® (Microcaya TempTest, Bilbao, Spain) contact. Fifty healthy volunteers were enrolled. Hot-water exposure increased TEWL (25.75 vs. 58.58 g·h-1·m-2), pH (6.33 vs. 6.65) and erythema (249.45 vs. 286.34 AU). Cold-water immersion increased TEWL (25.75 vs. 34.96 g·h-1·m-2) and pH (6.33 vs. 6.62). TEWL (7.99 vs. 9.98 g·h-1·m-2) and erythema (209.07 vs. 227.79 AU) increased after being in contact with the hot region (44 °C) of the TempTest. No significant differences were found after contact with the cold region (4 °C) of the TempTest. In conclusion, long and continuous water exposure damages skin barrier function, with hot water being even more harmful. It would be advisable to use cold or lukewarm water for handwashing and avoid hot water. Knowing the proper temperature for hand washing might be an important measure to prevent flares in patients with previous inflammatory skin diseases on their hands.

SARS-CoV-2 might transmit through the skin while the skin barrier function could be the mediator.

During the coronavirus disease 2019 (COVID-19) pandemic, it were reported that COVID-19 patients could have cutaneous symptoms, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was observed on the skin of COVID-19 patients, which indicated that the skin is one target of SARS-CoV-2. Meanwhile, reports about SARS-CoV-2 transmission through food cold-chain overpacks emerged. With the fact that SARS-CoV-2 could survive on the skin for more than 9 h, the skin could be implicated in SARS CoV-2 transmission. Angiotensin-converting enzyme 2 (ACE2), a critical membrane protein for SARS-CoV-2 that enters a host cell, was recognized to be associated with the risk of SARS-CoV-2 infection. Therefore, tissues that express ACE2 might have the potential to be infected by and transmit SARS-CoV-2. The skin is one such tissue that expresses ACE2. However, unlike the lung that expresses ACE2 on the upper-most epithelial layer, the skin is composed of different layers of cells that function as a barrier, and cells under the top epidermal layer express ACE2. Since the skin barrier is the first line of protection, the typical position of ACE2-expressing cells in the skin implies that the skin barrier function could be the mediator of SARS-CoV-2. In our study, we found that ACE2 could be expressed in the skin, and its expression level is increased in psoriasis, an inflammatory disease of the skin with barrier dysfunction. Additionally, by applying the SARS-CoV-2 pseudovirus on mouse models with or without deteriorated skin barrier, we found that the SARS-CoV-2 pseudovirus could infect the skin and lungs of mouse models, and when the skin barrier was impaired, more SARS-CoV-2-infected cells could be found. Thus, we hypothesized that a deteriorated condition of the skin barrier might increase the risk of SARS-CoV-2 infection through the skin.

Assessment of hand hygiene strategies on skin barrier function during COVID-19 pandemic: A randomized clinical trial.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has increased the frequency of handwashing. There is scarce evidence regarding the impact of different hand hygiene procedures on skin barrier function in clinical practice. OBJECTIVE: To compare the impact on skin barrier function of different hand hygiene measures in healthcare workers in daily practice. METHODS: A randomized controlled clinical trial was conducted. Participants were randomized to sanitize their hands with water and soap, alcohol-based hand sanitizers (ABHSs), or disinfectant wipes during their 8-hour working shift. Epidermal barrier functional parameters, such as transepidermal water loss (TEWL), and the microbial load were assessed before and immediately after the working day. Tolerance and acceptability of each product were recorded after work. RESULTS: Sixty-two participants were included and 20, 21, and 21 were randomized to use water and soap, ABHS, and disinfectant wipes, respectively. After the 8-hour shift, TEWL increase was higher with disinfectant wipes than with soaps or ABHS (+5.45 vs +3.87 vs -1.46 g h-1  m-2 , respectively; P = .023). Bacteria and fungi colony-forming unit (CFU) count reductions were lower for the water and soap group than for ABHS and disinfectant wipes. Disinfectant wipes were considered more difficult to use (P = .013) compared with water and soap and ABHS. CONCLUSION: Daily hand hygiene with ABHS showed the lowest rates of skin barrier disruption and the highest reduction of CFU.

Skin Barrier Damage due to Prolonged Mask Use among Healthcare Workers and the General Population during the COVID-19 Pandemic: A Prospective Cross-Sectional Survey in China.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has resurged in localized areas in China. Individuals wear masks to prevent the spread of droplets. However, skin barrier damage occurs because of the prolonged use of masks. OBJECTIVE: To investigate the prevalence and associated risk factors of skin injuries among healthcare workers (HCWs) and the general population during the COVID-19 outbreak. METHODS: A multicenter cross-sectional study of skin barrier damage caused by wearing masks was conducted using an online questionnaire between December 10 and December 31, 2020. Data regarding demographics, characteristics of facial skin damage, and information on masks were registered. Multivariate logistic regression was used to analyze factors associated with skin barrier damage, and odds ratios (OR) with 95% confidence intervals (CI) were used to establish correlation strength. RESULTS: A total of 1,538 responses were retrieved from 1,700 questionnaires (response rate, 90.47%), and 1,409 questionnaires were valid (effective response rate, 91.61%). The respondents comprised 567 HCWs (40.24%) and 842 individuals from the general population (59.76%). The prevalence of skin injuries was 46.03% among HCWs and 46.20% among the general population. History of chronic skin disease (OR, 6.01; 95% CI, 4.75-7.75), type of mask used (OR, 2.77; 95% CI, 1.95-3.93), daily wearing time (OR, 1.57; 95% CI, 1.36-1.82), and mask replacement cycle (OR, 0.76; 95% CI, 0.68-0.86) were associated with skin barrier damage. CONCLUSION: There was a high incidence of skin barrier damage due to prolonged mask use among HCWs and the general population, and treatment and prevention were inadequate. Attention needs to be given to strengthening comprehensive health education and popularization of science.

[Selected hand skin characteristics of laboratory diagnosticians]. / Wybrane cechy skóry dloni diagnostów laboratoryjnych.

BACKGROUND: Chronic skin exposure to a wet work environment, as well as disinfectants are factors contributing to epidermal barrier damage. This disturbs its protective functions and promotes the development of dermatoses. All these factors occur in the work environment of a laboratory diagnostician. The aim of the paper was to analyze selected skin parameters and skin lesions in the hands of laboratory diagnosticians. MATERIAL AND METHODS: Overall, 50 laboratory diagnosticians employed in a laboratory in Kraków, Poland, took part in the study. After the interview, the skin pH and moisture content were examined. Measurements were performed on the dorsal side of the dominant hand using the Skin-ph-Meter^® PH 905 and Corneometer^® CM 825 devices. RESULTS: The obtained moisture level values were qualified as dry or very dry skin, and the skin pH was within the reference range. No correlation between the skin pH value and the features examined (professional experience, the number of hours spent in protective gloves during the day, the number of hand washing episodes during the day) was not indicated. The level of skin moisture content seems to positively correlate with the time of wearing gloves. The use of hand moisturizers after each hand washing episode correlated with the level of skin moisture content. CONCLUSIONS: During the COVID-19 pandemic, this professional group has been facing huge challenges, and mental and physical stressors (including wet work environment) will be the source of future occupational diseases. Med Pr. 2020;71(6):725-34.

How irritant are n-propanol and isopropanol? - A systematic review.

BACKGROUND: The use of alcoholic-based hand rubs (ABHRs) is an important tool for hand hygiene, especially in times of the COVID-19 pandemic. Possible irritant effects of ABHR may prevent their use by persons at risk of infection. METHODS: This systematic review is based on a PubMed search of articles published between January 2000 and September 2019 in English and German, and a manual search, related to the irritation potential of alcohol-based disinfectants restricted to n-propanol (1-propanol) and its structural isomer isopropanol (isopropyl alcohol, 2-propanol). RESULTS: The majority of the included studies show a low irritation potential of n-propanol alone. However, recent studies provide evidence for significant barrier damage effects of repeated exposure to 60% n-propanol in healthy, as well as atopic skin in vivo. The synergistic response of combined irritants, (ie, a combination of n-propanol or isopropanol with detergents such as sodium lauryl sulfate) is greater, compared with a quantitatively identical application of the same irritant alone. CONCLUSION: While recent studies indicate a higher risk of skin irritation for n-propanol and isopropanol than reported in the past, this risk still seems to be lower than that for frequent handwashing with detergents, as recommended by some to prevent COVID-19 infections.