Irritancy testing of sodium laurate and other anionic detergents using an open exposure model

Background/aims: The irritant potency of soap (sodium laurate, LAU) as opposed to other anionic detergents is not uniformly agreed upon. The aim of the study was to compare the irritancy of sodium laurate with that of sodium laurylsulphate (SLS), sodium cocoyl isethionate and disodium lauryl 3-ethoxysulphosuccinate by means of a 4-day repeated open exposure model in order to achieve a more realistic mimicry of daily practice.Methods: The effects of the exposures were evaluated by: a) number of fulfilled exposures, b) visual score after exposures, and c) transepidermal water loss (TEWL) after exposures.Results: in the majority of subjects, exposure to LAU had to be stopped because of burning sensations, erythema and/or scaling. The number of fulfilled exposures to LAU was lower than that of SLS. The other agents were tolerated very well. These less irritative agents had much lower visual scores and TEWL values after the repeated exposures compared with LAU and SLS.Conclusions: The explanation for the irritant nature of LAU in the present study might be the type of alkyl chain length distribution. Its 12-carbon chain content was ≤ 99%, and this agent can therefore be designated as pure sodium laurate. The same holds true for SLS. In daily practice, however, soap is a mixture of different - less irritant - chain lengths. Therefore, these findings cannot be extrapolated to commercially available soap bars.</p

Evidence-Based Management of Hand Eczema

Hand eczema is a common skin disease with a wide variation in morphology and a complex etiology based on endogenous and exogenous factors.The diagnosis of hand eczema is based on patient history, exposure assessment, physical examination, and the results of patch testing. Management of hand eczema starts with education of the patient on the etiology of the disease, and the needed changes in behavior regarding skin care and preventive measures, and avoidance of relevant exposure factors. In many cases, medical treatment is needed for successful management of the disease; use of medication can only be successful with proper education and avoidance of relevant exposure

Irritancy testing of sodium laurate and other anionic detergents using an open exposure model

Background/aims: The irritant potency of soap (sodium laurate, LAU) as opposed to other anionic detergents is not uniformly agreed upon. The aim of the study was to compare the irritancy of sodium laurate with that of sodium laurylsulphate (SLS), sodium cocoyl isethionate and disodium lauryl 3-ethoxysulphosuccinate by means of a 4-day repeated open exposure model in order to achieve a more realistic mimicry of daily practice.Methods: The effects of the exposures were evaluated by: a) number of fulfilled exposures, b) visual score after exposures, and c) transepidermal water loss (TEWL) after exposures.Results: in the majority of subjects, exposure to LAU had to be stopped because of burning sensations, erythema and/or scaling. The number of fulfilled exposures to LAU was lower than that of SLS. The other agents were tolerated very well. These less irritative agents had much lower visual scores and TEWL values after the repeated exposures compared with LAU and SLS.Conclusions: The explanation for the irritant nature of LAU in the present study might be the type of alkyl chain length distribution. Its 12-carbon chain content was ≤ 99%, and this agent can therefore be designated as pure sodium laurate. The same holds true for SLS. In daily practice, however, soap is a mixture of different - less irritant - chain lengths. Therefore, these findings cannot be extrapolated to commercially available soap bars.</p

Severity scoring of atopic dermatitis: a comparison of three scoring systems

In studies on atopic dermatitis (AD), different scoring systems are used to evaluate the severity of the disease. The objective of this study was to investigate agreement between observers in the assessment of the overall severity of AD, and interobserver variation in the assessment of severity of AD for each scoring item separately, using the Simple Scoring System (SSS), the Scoring Atopic Dermatitis (SCORAD) index, and the Basic Clinical Scoring System (BCSS), and, furthermore, to investigate agreement between these three scoring systems in the assessment of the overall severity of AD. Eighty-two patients (42 male) with AD, mean age 13.4 years (range 0.2-67.0), were included. Agreement between observers in assessing the overall AD severity scores, and interobserver variation in assessing AD severity of each scoring item separately were determined in 34 of these 82 patients by two physicians scoring the severity of AD by the three scoring systems. To determine agreement between the scoring systems, one physician scored the severity of AD in all patients with the three scoring systems. Agreement between observers and agreement between the three scoring systems was calculated by Cohen's kappa (kappa) and by the measure of agreement according to Bland & Altman. kappa > 0.4 represents fair agreement; kappa > 0.75 excellent agreement. In addition, interobserver variation for each scoring item separately was calculated by the Wilcoxon signed rank test. The mean differences (d) and the limits of agreement (d +/- 2 SD of the differences) between observers by the SSS and the SCORAD were -0.82 +/- 5.58 and -0.28 +/- 7.49, respectively, kappa between observers for the BCSS was 0.90 (95% CI 0.79-1.03). By the SSS, significant interobserver variation was found in assessing the severity of excoriations (P = 0.02) and scales (P = 0.02). By the SCORAD, significant interobserver variation was found in assessing the severity of edema/population (P = 0.04), erythema (P = 0.04), and excoriations (P = 0.01). No significant interobserver variation was found in assessing the extent of AD. The mean difference and the limits of agreement between the SSS and the SCORAD were -4.17 +/- 9.52. kappa between the SSS and the BCSS was 0.21 (95% CI 0.09-0.33), and kappa between the SCORAD and the BCSS was 0.38 (95% CI 0.26-0.51). We found good agreement between observers assessing the overall severity of AD in the lower and higher scoring rates by the SSS and the SCORAD, and excellent agreement by the BCSS. Significant interobserver variation was found on the isolated intensity items scales, excoriations, edema/population, and erythema. We found poor agreement between the three scoring systems in assessing the overall severity of AD, indicating that the SSS, the SCORAD, and the BCSS cannot be used interchangeably to assess the overall severity of A

Nomenclatuur en scoresystemen chronische urticaria

The Dutch Guideline on urticaria is currently being developed. Whilst awaiting the guideline, this article already discusses the classification and score system. Chronic urticaria is defined as the occurrence of spontaneous wheals, angioedema or both for a period of at least six weeks. In the current classification, chronic urticaria is divided into chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CINDU). Several disease-specific questionnaires have been developed to assess patient-reported outcomes measures: the Urticaria Activity Score (UAS) and the Angioedema Activity Score (AAS) to assess disease activity, and the CU-Q2oL (Chronic Urticaria Quality of Life) and AE-QoL (Angio Edema Quality of Life) to assess quality of life. Disease specific questionnaires to assess disease activity, quality of life and use of medication in patients with CSU and/ or CINDU are the Urticaria Control Test (UCT) and the Urticaria Severity Score (USS). The guideline on chronic urticaria will provide recommendations on the use of these score systems