Skin may adapt to topical irritants through accommodation. This study focuses on long-term exposure to irritants and attempts to demonstrate accommodation. Sodium lauryl sulfate (SLS) induced irritant contact dermatitis at 3 concentrations (0.025% to 0.075%). Distilled water, acetone and an empty chamber served as controls. Experimental compounds were applied to forearms of 7 healthy volunteers for 24 hr before replacing by a fresh chamber for 6 non-consecutive weeks over 103 days. Possible accommodation was quantified by visual scoring (erythema and dryness) and by bioengineering parameters: transepidermal water loss (TEWL), capacitance, chromametry and laser Doppler flowmetry (LDF). Significant erythema, dryness, elevated TEWL, skin colour reflectance and LDF values occurred during the exposure periods. Upon repeat exposure, an immediate and augmented response in erythema, TEWL, skin colour reflectance and LDF developed. However, irritant skin changes were not sustained. Irritation parameters return to baseline after cessation of exposure. There was no evidence of sustained irritation or accommodation after the last exposure. Study findings do not document sustained accommodation or adaptive hyposensitivity after long-term repetitive irritant exposure under these test conditions. Alternative models should be developed to prove or disprove the accommodation hypothesis.

Background: Open application utilizing an exaggerated forearm washing model to determine surfactant subclinical irritant effects has limitations. Objective: A modified screening open model for rapid assessment of surfactant subclinical irritation was used as part of a validation process. Methods: Eight subjects were enrolled and 5 candidate surfactants studied. Sodium lauryl sulfate served as the irritant ‘gold standard’ control. In addition, one site for water washing and one site for normal skin (no treatment) were also included. A technician conducted 3 successive washings with each test surfactant to each volar forearm. Skin irritation and subclinical irritations were assessed with visual scores and bioengineering (transepidermal water loss, skin capacitance and skin color). Squamometry was performed after the last wash. Results: Squamometry provided a sensitive assessment for detecting surfactant-induced subclinical irritation with 3 successive washings in this open assay model. Neither clinical scores nor other biometric methods provided valuable biologic insight. Conclusion: This minimally invasive assay provides a facile and robust means to rank detergent irritant effects in man.

Introduction: It is well established that the use of corticosteroids is associated with the development of cataracts (posterior subcapsular cataract). This type of cataract is also related with cataract found in patients with atopic dermatitis. Since many patients use topical corticoids for treatment of skin diseases, it may be possible that an association between cataract (and glaucoma) and corticosteroids' treatment exists. Objective: Relating the cutaneous corticosteroid use and the development of cataract in patients with dermatologic disease. Material and Methods: A review of literature using Medline and citations in articles to obtain this case-report series. Results: Seven patients (all men) developed cataract while using topical corticosteroids for skin diseases. Three of these seven patients also presented with glaucoma, possibly as a complication of topical corticoid on the face. Conclusion: Cataract seems to be related to topical steroids' use in periocular skin, but their real importance needs to be evaluated.

Long-standing tradition (and standard textbooks) suggest that separating irritation and allergic contact dermatitis (and their biologies) is straightforward. This overview examines this dogma, stressing that the similarities (at least in the efferent limbs) may be as great as the mechanistic differences.

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