Effectiveness of skin protection creams as a preventive measure in occupational dermatitis: a critical update according to criteria of evidence-based medicine

Abstract

Objectives: This study attempts to assess the evidence of the generally recommended three-step programme of skin protection in the prevention of occupational skin disease. Methods: The following clinical questions, representative of critical appraisal of this preventive measurement, were generated: (1) Can a skincare regimen effectively reduce or eliminate work-related poor skin conditions? (2) Do protective creams prevent harmful substances from penetrating and adhering to the skin? (3) Is the differentiation between pre-exposure and post-exposure products justified by reliable data? Answers were generated according to the method used in evidence-based medicine by searching the literature, critically appraising the results and applying the results to the clinical questions. For our search we decided to use PubMed as the most convenient access to Medline and because, in contrast to other databases, this access is available free of charge. Results: To investigate the efficacy of barrier creams as pre-exposure skin protectors various in vitro and in vivo test methods have been developed. Over the past years the test techniques have been improved in order to adopt a real workplace situation. Efforts for standardisation of evaluation criteria have been made, too. Nevertheless, there is a lack of placebo-controlled, randomised clinical trials evaluating the benefit of these products in the prevention of occupational contact dermatitis under real workplace conditions. The literature data are conflicting; some publications report on the positive aspects of skin protection, whereas others stress the negative ones. Conclusion: Not enough data have been accumulated for one to prove the benefit of skin protection measures under real workplace condition. Up to now, it is almost unclear if the various in vitro and in vivo methods used are suit-able to simulate real workplace conditions and if these test results can be related to real occupational exposure. For the evidence-based recommendation of skin protection, further studies, especially under daily working conditions evaluating the contribution of each single element of skincare programme (products, frequency of application and education programme) are needed.

Effectiveness of skin protection measures in prevention of occupational hand eczema: results of a prospective randomized controlled trial over a follow-up period of 1 year

“…The second group consists of clinical studies confirming the efficacy of skin protective measures in highly standardized study designs. The third group includes studies reporting (even negative) effects of skin protection 9,10 . In order to put the results of the present study on the effectiveness of skin care/protection in a highly pragmatic setting into perspective we focused on clinical studies reporting either benefit or harm.…”

“…While protective creams (‘barrier creams’) are supposed to prevent skin damage due to contact with irritants, skin cleansing should be as mild as possible, yet capable of removing dirt from the skin. Finally, postexposure skin care with moisturizers is intended to enhance epidermal barrier regeneration 9,10 . The outcome of preventive strategies in terms of overall effectiveness depends both on the efficacy of the strategy itself and on acceptance and implementation of protective measures among the persons at risk, possibly supported by an educational training programme 9 .…”

“…Finally, postexposure skin care with moisturizers is intended to enhance epidermal barrier regeneration 9,10 . The outcome of preventive strategies in terms of overall effectiveness depends both on the efficacy of the strategy itself and on acceptance and implementation of protective measures among the persons at risk, possibly supported by an educational training programme 9 . We recently found a very low adherence to the generally recommended skin protection regimen in a sample of 1355 metalworkers.…”

Barrier Creams in Prevention of Hand Dermatoses

“…Program ochrony skóry W profilaktyce chorób zawodowych skóry zaleca się (3,6,54,56,58-60) stosowanie 3-stopniowego programu ochrony skóry, który obejmuje: n ochronę skóry -przez aplikację środków ochronnych przed pracą, n oczyszczanie skóry -przez mycie rąk łagodnymi środkami i wodą, n pielęgnację skóry -przez stosowanie kremów kosmetycznych po pracy. W 2003 r. Kütting i Drexler ocenili skuteczność tego programu w zmniejszeniu lub wyeliminowaniu stanów zapalnych skóry i zapobieganiu wnikaniu szkodliwych substancji oraz zróżnicowanie istotności wyników przed aplikacją środków ochronnych i po niej (58). Stwierdzono, że do udowodnienia korzyści ze stosowania środków ochrony skóry -zwłaszcza w rzeczywistych warunkach pracy -potrzebne są dalsze badania z uwzględnieniem oceny wpływu każdego elementu programu ochrony skóry (produktów, częstotliwości stosowania i programu edukacji).…”

Current acceptance and implementation of preventive strategies for occupational hand eczema in 1355 metalworkers in Germany

“…The outcome of preventive strategies depends on the efficacy of the strategy itself but also on acceptance and implementation of protective means among the persons at possible risk for hazardous health effects (effectiveness). The effectiveness of a skin care programme is based on three main factors: (i) the effectiveness of the products used; (ii) the frequency and diligence of the application of skin care products; and (iii) the positive impact of an educational training programme leading to a significant reduction of exposure to skin‐damaging substances 13 …”