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Skin of color: biology, structure, function, and implications for dermatologic disease.

People with skin of color constitute a wide range of racial and ethnic groups-including Africans, African Americans, African Caribbeans, Chinese and Japanese, Native American Navajo Indians, and certain groups of fair-skinned persons (eg, Indians, Pakistanis, Arabs), and Hispanics. It has been predicted that people with skin of color will constitute a majority of the United States and international populations in the 21st century. There is not a wealth of data on racial and ethnic differences in skin and hair structure, physiology, and function. What studies do exist involve small patient populations and often have methodologic flaws. Consequently, few definitive conclusions can be made. The literature does support a racial differential in epidermal melanin content and melanosome dispersion in people of color compared with fair-skinned persons. Other studies have demonstrated differences in hair structure and fibroblast size and structure between black and fair-skinned persons. These differences could at least in part account for the lower incidence of skin cancer in certain people of color compared with fair-skinned persons; a lower incidence and different presentation of photo aging; pigmentation disorders in people with skin of color; and a higher incidence of certain types of alopecia in Africans and African Americans compared with those of other ancestry. However, biologic or genetic factors are not the only ones impacting on these differences in dermatologic disorders. Cultural practices also can have a significant impact. Further studies are needed to help dermatologists optimally treat people with skin of color.

Humans↗

Hydration and plasticity following long-term use of a moisturizer: a single-blind study.

Skin hydration is thought to have an influence on skin plasticity, and moisturizers have therefore gained widespread use. However, the effects of long-term moisturizer use on the mechanical properties and the long-term correlation between plasticity and hydration of human skin in vivo remain unknown. Nineteen healthy volunteers applied a moisturizer to the volar surface of their forearms for 3 weeks, once daily on one arm and twice daily on the other. The skin capacitance, distensibility, hysteresis and elasticity were measured in both treated areas and in an untreated regional control area. Measurements were carried out at baseline, at one-week intervals during the trial and one week after the termination. Data were assessed in a single-blind fashion. No change was found in any of the mechanical parameters in the moisturizer-treated skin compared to the control. The capacitance of skin was found to increase independently of dose. One week after termination of the treatment, the skin capacitance remained increased. No dose-response effect was seen, however. Long-term use of moisturizers increases skin capacitance significantly, but does not change the mechanical properties. In vivo skin hydration is a poor predictor of skin mechanics.

Administration, Topical↗

Measurements of surface contamination of spray equipment with pesticides after various methods of application.

A traditional method to determine operator dermal exposure is to quantify the amount of pesticide coming into contact with specific body regions and then to integrate the deposition density values with the total body surface. It is known that extremely high deposition values may occur in the hand region; however, the source of contamination is generally assumed to be direct splash or contact with the pesticide container. One of the parameters affecting operator/pilot exposure could be the transfer of pesticide residue, particularly in the case of pesticides with a longer half-life, from contaminated surfaces of spray equipment by direct contact over extended periods. If the rate of skin absorption of pesticide is readily known, the expected values of daily dose for an operator or pilot may significantly rise due to the extended contact period. This study produced field data on the surface contamination of spray equipment used for ground and aerial applications. If field data on precise work practice (time-motion) observations are incorporated, it may be possible to estimate the potential exposure of operator/pilot due to hand contact with contaminated surfaces.

Aerosols↗

Harmful effects of UVA on the structure and barrier function of engineered human cutaneous tissues.

PURPOSE: To investigate the effects of a single UVA exposure on engineered human cutaneous tissues. MATERIALS AND METHODS: Skin equivalents (SE) were obtained by culturing keratinocytes on fibroblast-populated collagen gels; epidermal equivalents (EE) were obtained by seeding keratinocytes on non-populated collagen gels. After maturation and differentiation of the epidermis, SE and EE were exposed to 50 or 100 J/cm2 UVA. Structural damage and total epidermal lipids were analysed and diffusion of radioactive oestradiol was monitored 24 and 72h post-irradiation. RESULTS: Twenty-four hours after UVA irradiation, a disorganization of the living epidermis is observed. UVA also significantly reduced the skin barrier function and led to an increase in phospholipid and in a decrease of ceramide levels. However, both the structure and the barrier function of SE were recovered 72 h post-irradiation, thereby suggesting that an intrinsic repair process might exist within the irradiated SE. CONCLUSION: This study provides a strong evidence that UVA radiation alters both the epidermal and dermal structures, the synthesis of epidermal lipids, and the permeability of the human skin.

Cells, Cultured↗

Transdermal drug delivery systems of a beta blocker: design, in vitro, and in vivo characterization.

The matrix type transdermal drug delivery systems (TDDS) of metoprolol were prepared by film casting technique using a fabricated stainless steel film casting apparatus and characterized in vitro by drug release, skin permeation, skin irritation, and in vivo pharmacodynamic and stability studies. Four formulations were prepared that differed in the ratio of matrix forming polymers. Formulations M-1, M-2, M-3, and M-4 were composed of Eudragit RL-100 and polyvinyl acetate with the following ratios: 2:8, 4:6, 6:4, and 8:2, respectively. All the four formulations carried 10% (w/w) of metoprolol tartrate, 5% (w/w) of dibutylphthalate, and 5% (w/w) of (+/-) menthol in dichloromethane:isopropyl alcohol (80:20 v/v). Cumulative amount of drug released in 48 hr from the four formulations was 79.16%, 81.17%, 85.98%, and 95.04%. The corresponding values for cumulative amount of drug permeated for the said formulations were 59.72%, 66.52%, 77.36%, and 90.38%. On the basis of in vitro drug release and skin permeation performance, formulation M-4 was found to be better than the other three formulations and it was selected as the optimized formulation. The formulation appeared to be stable when stored at 40 degrees C and 75% RH with negligible degradation of the drug. The TDDS was found to be free of any skin irritation as suggested by skin irritation score of 1.16 (<2.00) under Draize score test. Statistically significant reduction in mean blood pressure (p < .01) was achieved in methyl prednisolone-induced hypertensive rats on treatment with the TDDS.

2-Propanol↗

Amended final report on the safety assessment of polyacrylamide and acrylamide residues in cosmetics.

Polyacrylamide is a polymer of controllable molecular weight formed by the polymerization of acrylamide monomers available in one of three forms: solid (powder or micro beads), aqueous solution, or inverse emulsions (in water droplets coated with surfactant and suspended in mineral oil). Residual acrylamide monomer is likely an impurity in most Polyacrylamide preparations, ranging from <1 ppm to 600 ppm. Higher levels of acrylamide monomers are present in the solid form compared to the other two forms. Polyacrylamide is reportedly used in 110 cosmetic formulations, at concentrations ranging from 0.05% to 2.8%. Residual levels of acrylamide in Polyacrylamide can range from <.01% to 0.1%, although representative levels were reported at 0.02% to 0.03%. Because of the large sizes of Polyacrylamide polymers, they do not penetrate the skin. Polyacrylamide itself is not significantly toxic. For example, an acute oral toxicity study of Polyacrylamide in rats reported that a single maximum oral dose of 4.0 g/kg body weight was tolerated. In subchronic oral toxicity studies, rats and dogs treated with Polyacrylamide at doses up to 464 mg/kg body weight showed no signs of toxicity. Several 2-year chronic oral toxicity studies in rats and dogs fed diets containing up to 5% Polyacrylamide had no significant adverse effects. Polyacrylamide was not an ocular irritant in animal tests. No compound-related lesions were noted in a three-generation reproductive study in which rats were fed 500 or 2000 ppm Polyacrylamide in their diet. Polyacrylamide was not carcinogenic in several chronic animal studies. Human cutaneous tolerance tests performed to evaluate the irritation of 5% (w/w) Polyacrylamide indicated that the compound was well tolerated. Acrylamide monomer residues do penetrate the skin. Acrylamide tested in a two-generation reproductive study at concentrations up to 5 mg/kg day(- 1) in drinking water, was associated with prenatal lethality at the highest dose, with evidence of parental toxicity. The no adverse effects level was close to the 0.5 mg/kg day(- 1) dose. Acrylamide tested in a National Toxicology Program (NTP) reproductive and neurotoxicity study at 3, 10, and 30 ppm produced no developmental or female reproductive toxicity. However, impaired fertility in males was observed, as well as minimal neurotoxic effects. Acrylamide neurotoxicity occurs in both the central and peripheral nervous systems, likely through microtubule disruption, which has been suggested as a possible mechanism for genotoxic effects of acrylamide in mammalian systems. Acrylamide was genotoxic in mammalian in vitro and in vivo assays. Acrylamide was a tumor initiator, but not an initiator/promoter, in two different mouse strains at a total dose of 300 mg/kg (6 doses over 2 weeks) resulting in increased lung adenomas and carcinomas without promotion. Acrylamide was tested in two chronic bioassays using rats. In one study, increased incidence of mammary gland tumors, glial cell tumors, thyroid gland follicular tumors, oral tissue tumors, uterine tumors and clitoral gland tumors were noted in female rats. In male rats, the number of tumors in the central nervous system (CNS), thyroid gland, and scrotum were increased with acrylamide exposure. In the second study, using higher doses and a larger number of female rats, glial cell tumors were not increased, nor was there an increase in mammary gland, oral tissue, clitoral gland, or uterine tumors. Tumors of the scrotum in male rats were confirmed, as were the thyroid gland follicular tumors in males and females. Taken together, there was a dose-dependent, but not statistically significant, increase in the number of astrocytomas. Different human lifetime cancer risk predictions have resulted, varying over three orders of magnitude from 2 x 10(- 3) to 1.9 x 10(- 6). In the European Union, acrylamide has been limited to 0.1 ppm for leave-on cosmetic products and 0.5 ppm for other cosmetic products. An Australian risk assessment suggested negligible health risks from acrylamide in cosmetics. The Cosmetic Ingredient Review (CIR) Expert Panel acknowledged that acrylamide is a demonstrated neurotoxin in humans and a carcinogen in animal tests, but that neurotoxic levels could not be attained by use of cosmetics. Although there are mechanisms of action of acrylamide that have been proposed for tumor types seen in rat studies that suggest they may be unique to the rat, the Panel was not convinced that these results could be disregarded as a species-specific finding with no relevance to human health and safety. Based on the genotoxicity and carcinogenicity data, the Panel does not believe that acrylamide is a genotoxic carcinogen in the usual manner and that several of the risk assessment approaches have overestimated the human cancer risk. The Panel did conclude, however, that it was appropriate to limit acrylamide levels to 5 ppm in cosmetic formulations.

Acrylamides↗

Estradiol pharmacokinetics after transdermal application of patches to postmenopausal women: matrix versus reservoir patches.

OBJECTIVE: A new matrix 17 beta-estradiol transdermal patch incorporating lauric acid to improve estradiol skin absorption has been designed for hormone replacement therapy. Estradiol pharmacokinetics obtained with the prototype, its industrial counterpart, a matrix-type, System 50, and a reservoir-type, Estraderm TTS 50, transdermal patch have been compared. Each device delivers 50 micrograms estradiol daily. METHODS: Twenty postmenopausal women received each of the four formulations for 3 days in a Latin-square design and with a minimum 4-day wash-out period between treatments. Estradiol plasma concentrations were measured by radioimmunoassay at 6, 12, 24, 48 and 72 h after application. RESULTS: The prototype patch and its industrial counterpart showed no significant difference in estradiol delivery, with 72-h systemic exposure to estradiol similar to that of the reservoir patch but greater than that of the reference matrix formulation, with average baseline-corrected concentrations (SEM) of 35 (4), 32 (3), 32 (2) and 19 (1.8) pg/ml, respectively. In addition, they ensured more stable delivery, with coefficients of variation of plasma estradiol concentrations (12-72 h) of 29, 41, 63 and 84%, respectively. All matrix patches demonstrated the same patients to be poor estradiol absorbers, different from those encountered with the reservoir patch type, despite an improved estradiol bioavailability with the lauric acid-containing matrix patch. CONCLUSION: Matrix patches incorporating lauric acid led to estradiol plasma levels more stable than with the reference matrix and reservoir patches, and greater than those with the reference matrix patch.

Administration, Cutaneous↗

A portable chemical protective clothing test method: application at a chemical plant.

The National Institute for Occupational Safety and Health (NIOSH), in cooperation with Monsanto Chemical Company, conducted an on-site evaluation of chemical protective clothing at Monsanto's Nitro, West Virginia plant. The Monsanto plant manufactures additives for the rubber industry including antioxidants, pre-vulcanization inhibitors, accelerators, etc. This survey evaluated six raw materials that have a potential for skin absorption: aniline, cyclohexylamine, diisopropylamine, tertiary butylamine, morpholine and carbon disulfide. Five generic glove materials were tested against these chemicals: nitrile, neoprene, polyvinylchloride, natural latex and natural rubber. The NIOSH chemical permeation portable test system was used to generate breakthrough time data. The results were compared to permeation data reported in the literature that were obtained by using the ASTM F739-85 test method. The test data demonstrated that aniline has too low a vapor pressure for reliable analysis on the portable direct reading detectors used. The chemical permeation test system, however, provided comparable, reliable permeation data for the other tested chemicals. Monsanto has used this data to better select chemical protection clothing for its intended use.

Chemical Industry↗

Evaluation of glove material resistance to ethylene glycol dimethyl ether permeation.

Some glycol ethers have been reported to cause adverse reproductive effects in exposed male and female workers, and skin absorption has been determined to be an important route of entry of this class of chemicals. Because ethylene glycol dimethyl ether (EGDME) is a possible component of lithium-based primary battery electrolyte systems, a study was undertaken to determine the resistance of various commercially available gloves to permeation of this liquid. The gloves were tested by the ASTM Method F-739-81, and butyl rubber was found to be the most effective barrier to permeation. Further studies determined that the butyl gloves could be reused if they were reconditioned overnight in a vacuum oven at 50 degrees C. When a mixture of ethylene glycol dimethyl ether (30% v/v) and propylene carbonate (70% v/v) was tested, the results indicated that the propylene carbonate retards the permeation of the glycol ether by a factor of 10. This is believed to be caused by the propylene carbonate coating the surface of the butyl membrane to reduce the sorption of EGDME.

Elastomers↗

Dimethylacetamide, ethylenediamine, and diphenylmethane diisocyanate poisoning manifest as acute psychosis and pulmonary edema: treatment with hemoperfusion.

CASE REPORT: A 27-year-old man, employed by a synthetic fiber company, had been exposed to dimethylacetamide, ethylenediamine, and diphenylmethane diisocyanate in a confined space continuously for 4-6 hours per day for 3 days before admission. Hallucinations and delusions were noted at admission; pulmonary edema developed subsequently. The electroencephalogram showed diffuse moderate cortical dysfunction and slow waves at 4-7 Hz, 20-80 microV. Seizures, liver injury, and rhabdomyolysis were noted on the 4th hospital day. The patient was treated by hemoperfusion with a decrease in urine dimethylacetamide from 3,265 mg/g to 4 mg/g creatinine over 4 days. Serial urinary dimethylacetamide and electroencephalogram correlated with the clinical condition.

Acetamides↗

Characterization of amphotericin B liposome formulations.

Liposomes composed of hydrogenated soya phosphatidylcholine (Emulmetik 950)/cholesterol/charged lipids [dicetyl phosphate (-) or stearylamine (+)] were developed. The hydrogenated soya phosphatidylcholine/cholesterol/charged lipid liposomes at molar ratios of 1:1:0, 7:2:0, 7:2:1 (-), and 7:2:1 (+), with and without the entrapped amphotericin B (0.05 mg AmB/mg lipid), were prepared by a chloroform-film method with sonication. The charges of liposomes were characterized by a Zeta-Meter. The negative liposomes with and without the entrapped AmB showed higher surface charge density than other formulations. The size distribution of liposomes determined by standard error of the mean (SEM) was in the range of 0.115 to 0.364 microm. The smallest size was observed in the negative liposomes with the entrapped drug [7:2:1 (-) AmB]. The lamellarity of more than 15 layers was observed by transmission electron microscope (TEM) in the neutral liposomes with the entrapped drug [7:2 AmB]. The transition temperature and enthalpy of transition (deltaH) were determined by differential scanning calorimetry (DSC). Positive liposomes with the entrapped and unentrapped AmB demonstrated higher deltaH of the first peak than other formulations, indicating higher rigidity of liposomal membrane. The AmB contents in liposomes were determined by high-performance liquid chromatography (HPLC) with ultraviolet (UV) detection at 382 nm. The percentages of entrapment of AmB in all formulations were above 85%. The positive liposome [7:2:1 (+) AmB] formulation, which gave the highest thermal stability, was selected for further skin absorption evaluation.

Amphotericin B↗

The penetration of sodium into the epithelium of the frog skin.

The aim of this paper is twofold. First, to describe a method for the measurement of the unidirectional flux of Na from the outer bathing solution into epithelium (J(OT)), and second, to describe the use of this method under a variety of experimental conditions in order to obtain some insight into the nature of this flux. The method developed is based on the exposure of a frog skin to a Ringer solution containing (22)Na. The exposure is made so that neighboring points along the surface remain in contact with the (22)Na solution for gradually longer periods, ranging from 0 to 46 sec. Some 8 to 10 samples of the exposed part are used to obtain the time course of the uptake of (22)Na and this time course is used, in turn, to evaluate J(OT). This flux is then studied in skins mounted between two identical Ringer solutions with 115 mM Na (11.25 +/- 0.10 [18] micromole.hr(-2) cm(-2)), and in skins mounted with Ringer with 1 mM Na on the outside and 115 mM Na on the inside (0.43 +/- 0.05 [18] micromole.hr(-1).cm(-2). From the observations that the flux is much larger than the net Na flux across the whole skin, that it is inhibited by K(+), and is unaffected by ouabain, it is concluded that the penetration of Na(+) into the epithelium does not occur by simple diffusion and is not directly dependent on an ouabain-sensitive mechanism. In the course of these experiments it was observed that when the skin was crushed between two chambers the uptake of Na in the neighboring exposed areas was decreased.

Animals↗

Direct measurement of uptake of sodium at the outer surface of the frog skin.

A combination of the methods described by Schultz et al. (6) and by Ussing and Zerahn (9) was used to measure directly the unidirectional uptake of sodium from the outside solution into the frog skin, under short-circuit conditions. The sodium uptake was determined at six sodium concentrations ranging from 3.4 to 114 mM. NaCl was replaced by choline chloride in the solutions bathing both sides of the skin. Sodium uptake is not a linear function of sodium concentration but appears to be composed of two components, a saturating one and one that varies linearly with concentration. The sodium uptake is inhibited by the addition of lithium to the outside solution. The effect appears to be primarily on the saturating component and has the characteristics of competitive inhibition. In addition, lithium uptake by the skin is inhibited by sodium. The effects of lithium cannot be ascribed to changes in electrical potential difference. Measurements with microelectrodes indicate that under short-circuit condition there is no change in the intracellular potential when lithium chloride is added to the outside solution.

Animals↗

An occupational hygiene investigation of exposure to acrylamide and the role for urinary S-carboxyethyl-cysteine (CEC) as a biological marker.

Acrylamide has a range of toxicological hazards including neurotoxicity and reproductive toxicity; however, occupational risk management is driven by its genotoxic and carcinogenic potential (it is classified within the EU as a Category 2 carcinogen, R45 and Category 2 mutagen, R46). Since there is the potential for skin absorption and systemic toxicity, biological monitoring may be a useful aid for the assessment of exposure via inhalation, ingestion and dermal absorption. However, there are currently no biological monitoring guidance values (BMGVs). This study describes an extensive survey of potential workplace exposure to acrylamide at the Ciba (Bradford) site to gather data suitable for a BMGV. This manufacturing site is typical within the industry as a whole and includes a cross section of activities and tasks representative of acrylamide exposure. Acrylamide is used in the manufacture of polyacrylamide based products for applications in water treatment; oil and mineral extraction; paper, paint and textile processes. Workers (62 plus 6 controls) with varying potential exposures provided a total of 275 pre shift and 247 post-shift urine samples along with 260 personal air samples. A small non-exposed control group was similarly monitored. Urine samples were analysed for S-carboxyethyl-cysteine (CEC). Airborne, surface and glove samples were analysed for acrylamide. Inhalation exposures were well controlled with values consistently below one-tenth of the UK Workplace Exposure Limit. Engineering controls, personal protective equipment and work practice, all contributed to good control of occupational exposure. CEC was found in urine samples from both exposed workers and non-occupationally exposed controls. At the low levels of exposure found, smoking made a significant contribution to urinary CEC levels. Nevertheless a correlation between urinary CEC and airborne acrylamide was found. A mixed effects model incorporating inhalation concentrations of acrylamide and smoking habits could predict some of the variation in observed post-shift urine results but could be improved through the use of additional surface contamination data. However, the data does not suggest that dermal absorption was a major contributor to the systemic dose. Based on the 90th percentile of the data, inclusive of the effects of smoking and environmental factors, a value of 4 mmol mol(-1) creatinine is proposed as a pragmatic BMGV associated with good occupational hygiene practice and control of workplace exposure. CEC in urine analysis has the utility for routine use as a means to estimate biological uptake where there is a potential for significant exposure or loss of workplace control.

Acrylamide↗

Preventable exposure to trimethyl tin chloride: a case report.

Trimethyl tin chloride (TMTC) is a highly toxic organotin compound that affects four main target organs: the brain, liver, immune system and skin. Exposure can occur by inhalation, ingestion or direct skin absorption. Trimethyl tin is but one of many hazardous substances with potentially serious health consequences to which individuals working in research laboratories may be exposed. We report a preventable case of TMTC exposure. Better understanding of the Canadian Workplace Hazardous Materials Information System (WHMIS) legislation and its applicability to the research laboratory situation would prevent such unnecessary exposure to hazardous substances.

Adult↗