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Artificial disruption of skin barrier prior to irritant patch testing does not improve test design
Author(s) -
Gebhard K.L.,
Effendy I.,
Löffler H.
Publication year - 2004
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/j.1365-2133.2004.05700.x
Subject(s) - transepidermal water loss , patch test , erythema , dermatology , penetration (warfare) , irritant contact dermatitis , biomedical engineering , surgery , medicine , chemistry , contact dermatitis , stratum corneum , mathematics , pathology , allergy , operations research , immunology
Summary Background Irritant patch testing is often performed as a 24‐ or 48‐h occlusive patch test with low concentrations of sodium lauryl sulphate (SLS). Objectives The aim of this study was to investigate potential ways to shorten this test procedure and obtain precise test results. Patients and methods Thirty‐six healthy volunteers underwent irritant patch testing with different pretreatments (PT) of the test fields. Occlusive test chambers were applied on the upper back with SLS 0·5%, 1%, 2% and 5% in large Finn Chambers ® . The patches were removed after 4 and 24 h, respectively, depending on the concentration used. Test fields were pretreated as follows: PT 0, field without any PT (control); PT 1, prick with lancet; PT 2, prick with test stamp; PT 3, scratch with lancet; PT 4, incision with standardized incision instrument (0·1–0·2 mm depth). Skin reactions were evaluated by transepidermal water loss (TEWL), skin erythema and skin hydration and as well by a visual score (VS) at 4, 24 and 72 h. Results Our data show an obvious distinction between PT 0–2 and PT 3–4 at all measurement methods. The average TEWL values with PT 3–4 were higher than those with PT 0–2, especially on the 4‐h course. This distinction may derive from the shape and size of the skin impairment achieved by PT 3–4, leading to a mechanical barrier disruption. However, SLS may infiltrate directly into deeper skin layers supported by capillarity. Consequently, no or little penetration through the epidermis and interaction with its structures occurs, which is responsible for irritant skin reactions. The SLS dose in the upper skin layers is therefore lower at these PTs. The lower remaining dose of SLS also explains this distinction, especially for the VS. Additionally, there are presumed reactions in deeper layers of the epidermis and dermis at PT 3–4. Conclusions In summary, all data suggest a different reaction pattern from the classical irritant response. Therefore, application without any PT seems to be best suited for irritancy skin testing, especially for visual assessment. PTs prior to irritant patch testing have been shown to be unjustifiable.