ABSTRACT
The stratum corneum's (SC) functions include protection from external hazardous environments, prevention of water loss and regulation of body temperature. While intact skin absorption studies are abundant, studies on compromised skin permeability are less common, although products are often used to treat affected skin. We reviewed literature on percutaneous absorption through abnormal skin models. Tape stripping is used to disrupt water barrier function. Studies demonstrated that physicochemical properties influence the stripping effect: water-soluble drugs are more affected. Abrasion did not affect absorption as much. Freezing is commonly used to preserve skin. It does not seem to modify water absorption, but still increases the penetration of compounds. Comparatively, heating the skin consistently increased percutaneous absorption. Removing SC lipids may increase percutaneous absorption of drugs. Many organic solvents are employed to delipidize. Delipidization with chloroform-methanol increased hydrophilic compound permeability, but not lipophilic. Acetone pre-treatment enhanced hydrophilic compound penetration. More data is needed to determine influence on highly lipophilic compound penetration. Sodium lauryl sulfate (SLS) induces irritant dermatitis and is frequently used as a model. Studies revealed that SLS increases hydrophilic compound absorption, but not lipophilic. However, skin irritation with other chemicals increases lipophilic penetration as much as hydrophilic. Animal studies show that UV exposure increases percutaneous absorption whereas human studies do not. Human studies show increased penetration in psoriatic and atopic dermatitis skin. The data summarized here begin to characterize flux alteration associated with damaged skin. Understanding the degree of alteration requires interpretation of involved conditions and the enlarging of our database to a more complete physicochemical spectrum.
Subject(s)
Dermatitis, Atopic/physiopathology , Dermatitis, Irritant/physiopathology , Skin Absorption , Skin/drug effects , Animals , Disease Models, Animal , Fatty Acids, Essential/metabolism , Humans , Permeability , Skin/pathology , Sodium Dodecyl Sulfate/metabolismABSTRACT
Allergic contact dermatitis remains an important problem worldwide. The objective of this study was to analyze patch test positivity trends of the North American Contact Dermatitis Group. Publications from 1970 to 2002 were reviewed and re-analyzed. Statistical significance was determined with a Cochran-Armitage trend test. We observed a significant increase in positive reactions with carbamates, balsam of Peru, thimerosal, formaldehyde, imidazolidinyl urea, and methyldibromoglutaronitrile. The rates of positive reactions to Dimethylol dimethyl (DMDM) hydantoin, diazolidinyl urea, and methylchloroisothiazolone/methylisothiazolone remained unchanged. We showed a significant decrease in positive reactions for all other allergens. These data provide challenges in public health--for industry, government, and medicine--to decrease the frequency of allergic contact dermatitis. However, the complexities of evaluating a 32-year analysis are numerous, so the data should be interpreted with caution and within the context of this work.
Subject(s)
Allergens/adverse effects , Dermatitis, Allergic Contact/epidemiology , Patch Tests/trends , Anesthetics, Local/adverse effects , Humans , Perfume/adverse effects , Preservatives, Pharmaceutical/adverse effects , Rubber/adverse effects , TimeABSTRACT
OBJECTIVES: In a teaching hospital where infectious disease specialists were routinely consulted for infections in patients in other departments, we sought to assess adherence to the specialists' recommendations, identify the factors influencing adherence, and measure the proportion of nosocomial infections among these consultations. METHODS: We collected data from intrahospital consultations with infectious disease specialists over a 4-week period. Afterwards (48 hours later), a physician and pharmacist collected all prescriptions for anti-infectious agents (dose, drug, combinations) and other orders (laboratory tests, radiology examination, isolation) for each patient. RESULTS: There were 174 infectious disease consultations requested for 143 inpatients during the study period. Anti-infectious agents were prescribed for 52.4% of patients, modified for 22.4%, and stopped for 9.1%; 16.1% neither had nor required such treatment. The rate of adherence to the specialists' recommendations was 84.6% for anti-infectious prescriptions and 77.4% for other orders. The factors associated with adherence were a bedside consultation (p = 0.04) and a recommendation to stop rather than modify anti-infectious treatment (p = 0.02). Roughly 40% of the patients (n = 57) had a nosocomial infection, most often during hospitalization for surgery (53.1% versus 29.1%, p < 0.01). Consultations were requested for 20% of the nosocomial infections observed at Grenoble University Hospital (based on annual prevalence in 2005). CONCLUSIONS: The specialist's presence at the patient's bedside has an impact on staff adherence to recommendations. These specialists play a vital role in managing nosocomial infections, which account for more than a third of these intrahospital' consultations.
