Maintenance of an intact skin barrier is very important to prevent contact dermatitis, and to avoid infections and adverse systemic health effects resulting from contact with chemicals from the outside.

The skin (Fig 01) barrier is physically located in the Stratum Corneum (SC) (Fig 02) on Epidermis, which is composed of protein-enriched cells and lipid-enriched intercellular domains, making of cellular tissue, a fabric of cornified cells, creating a tough, flexible, coherent membrane.

This design minimizes the water loss, electrolytes, and other body constituents and decreasing the entry of noxious substances from the external environment.

A key function of the skin barrier is to maintain the water concentration gradient between the body (high water concentration) and the outside world (low water concentration). Through the combination of keratin containing corneocytes and intercellular lipids in the stratum corneum provides a highly efficacious barrier against unintentional water loss.

The skin’s acid mantle is a key factor that determines the skin barrier integrity. pH of a healthy skin is in between pH 4.5-5.5, which facilitates production of intercellular lipids by pH dependent biochemical reactions.

What about the Hygroscopy of SC?

Healthy stratum corneum typically has a water content of 10–20%.

Increasing stratum corneum hydration can progressively reduce its barrier efficiency. Stratum corneum is extremely hygroscopic: it can pick up 500% of its dry weight in less than 1h, swelling vertically to 4–5 times its original width.

The water permeability barrier of the skin is regulated primarily by the lamellar arrangement of the lipid bilayers. Disruption of the barrier normally results in stimulation of DNA and the increase in the synthesis of free fatty acids, sphingolipids and cholesterol, leading to barrier repair.

What can disturb the SC barrier?

Physical and chemical factors can disrupt the barrier function. Skin barrier is chemically disrupted when healthy skin pH is altered by frequent hand hygiene practices that uses alkaline soaps and detergents, alcohol-based hand rubs and antimicrobials. Physical damages can be occurred by skin occlusion.

What would be effect if the barrier is compromised?

Factors causing impairment of skin barrier function resulting from impacts from the environment include exposure to irritants and allergens and pathogens.

Individual with pre-existing comorbidities, such as atopic dermatitis, make some individuals more susceptible to the development of contact dermatitis (CD).

How major is the ICD toward Occupational health?

Occupational skin diseases are ranked internationally as the second largest group of occupational diseases after musculoskeletal disorders and represent approximately 40% of occupational illness, with high costs due to medical consultations, (prolonged) sick leave and job change.

The bulk of occupational skin disease is contact dermatitis (CD is one major issue) affecting the hands, and one of the most important risk factors for developing hand eczema is wet work. Almost 20% of workers in wet-work occupations have reported hand eczema. CD makes up around 80% of all occupational skin diseases.

CD (Fig 03) is an inflammation of the upper layers of the skin, which may manifest itself with the main signs and symptoms of dryness, redness, itching, flaking, scaling, cracking, blistering, and pain.

And it is identified through studies wearing ‘wet -work or occupational’ safety gloves lead to CD condition. One of the major identified is ICD (Irritant Contact dermatitis), occur by wearing liquid-impervious gloves for prolong use consistently. This effect is individual depended, but the damage is common, and which is invisible toward naked eye, but rather post identified after trauma.

How Wet work relate to Occupation gloves?

EU directives 98/24/EC of 1998 and international labor organization (ILO) convention 170 of 1990 (safety in the use of chemicals at work), do not include wet work as a dangerous factor. However, in the current German technical regulations on hazardous substances TRGS 401 (June 2008), e.g. work is regarded as a wet occupation if workers are exposed to humid environments or wear impermeable gloves for more than a total of 2 h per work shift is defined as wet work.

TRGS 401 / 2008

"3.3.4 Hazardous working conditions, including wet work

(2) The employer must determine whether the criteria for wet work are present. Wet work includes activities where the workers …...

(3) Wear protective gloves with occlusion effects (accumulation of heat and moisture) for a corresponding period. The liquid-tight effect of protective gloves prevents the dissipation of perspiration to the outside and so the skin swells up as the time the gloves are worn increases, which lessens their barrier effect. Because the skin is pre-damaged in this way, it becomes easier for irritants, potentially allergenic (sensitizing) substances or infectious agents to penetrate ……"

Wearing of gloves for >2h during work hours quantitatively enough for the triggering of irritant contact dermatitis.

How impermeable gloves cause this effect?

In many industrial and food fields, protective gloves or clothing are required to protect the workers from hazardous materials or to maintain hygiene.

And these protective gloves generate an Occlusion during the wearing on the skin surface.

And this Occlison will head to causes SC over-hydration and reduces the protective barrier properties of the skin.

What is Occlusion?

Occlusion refers to covering the skin with impermeable or semipermeable materials, which prevent normal evaporation from the skin surface. Its irritant effects are considered to arise from the accumulation of moisture. Additional effects on the skin are considered to arise from increased temperature, sweating(perspiration), and increased pH.

During wearing water-resistant gloves on a task, frequent movement and the working of the hand will cause thermal generation due to energy loss though the hand skin surface.

To accommodate the thermal generation on the skin, body responds with thermal regulation naturally by developing perspiration. Where the major component of water will evaporate with absorbing the excessive heat to accommodate the thermal regulation.

During wearing of liquid impervious skin protective barrier on top of skin surface, the evaporation effect is disrupted causing the moisture to trap within with the heat generated. This leads to an environment called Occlusive environment. As the trapped heat and moisture leads to more elevated thermal level body responds by generating excessive Sweat naturally to accommodate the condition, this causes over- hydration on the skin surface. As explained in previous this over-hydration blocks diffusional water loss from skin surface and will reabsorbed by the SC hydration (Water content can be increased up to 50% with occlusion) occure during the Occlusion and causing disruption on the protective barrier of the skin (Fig 04 & 05).

Occlusion also has been shown to lead to a significant increase in skin pH which alter the healthy acid mantle acidity of the skin. This alkaline skin pH will delay the repair action of the skin barrier which occurred due to occlusion.

Occlusion health hazard?

Occlusive environment is a found to be effective for wound healing on medical therapies with the required medication, but this will be a major issue for healthy normal skin wearing of protective barrier.

Hydration by occlusion leading to susceptibility toward external harms permitting dermatitis effect dermatologists have called ‘hydration dermatitis’, leading toward Irritant contact dermatitis (ICD) even in condition on healthy skin personals.

Occlusion make the skin swelled and giving a texture as of spongy and white appearance just after remove of glove worn for prolong time, but this would disappear in some time leaving a disrupted skin surface which is not visible to naked eye (Fig 06).

ICD may develop through the tandem effects of long-term glove occlusion and the accumulation of barrier damage from hand washing, even when mild hand cleansers are employed.

Furthermore, at the workplace, glove occlusion is often accompanied by exposure to detergents, which might negatively affect the skin-damaging effect of gloves.

Also, over-hydration of the skin alters diffusion across the skin and the solubility of a penetrant in the stratum corneum . Many gloves do not resist the penetration of low molecular weight chemicals: those chemicals may enter the glove and become trapped on the skin under occlusion for many hours, possibly leading to irritation, and more seriously, to dermatitis or eczematous changes (Fig 03).

The repair capacity of the skin is not able to compensate for the damage, before new irritation occurs. Therefore, the new damage successively builds upon previous damage and impairs the barrier functions of the skin (Fig 07).

Glove related skin irritations was reported among dental and health care personals in and average of 29%, during the studies of occlusion.

Experiment studies shown (in animal testing) delay epidermal barrier repair during occlusion. Occlusion has been reported to influence cytokine production in murine skin.

excessive stratum corneum hydration which otherwise may render the skin more vulnerable to irritating agents or mechanical forces.

They appeared surprised to find that wearing nitrile or natural rubber latex gloves resulted in an increase. What they had not recognized is that this chemical will quickly migrate through the glove materials and then contact the skin.

The findings suggest that, after water exposure or the use of occlusive gloves, the irritant effect of detergent might be aggravated, and the skin seems to be more prone to react to stress.

It is lined out that wet occupation can cause chronic hand dermatitis and requires measures of primary prevention of occupational skin diseases.

As due to the requirement of wearing protective gloves is mandatory for the Occupational health and long term use of liquid impervious protective gloves in repeated considerable duration on at a time for long term negative effect of repetitive occlusions on SC will likely to cause an impairment of skin barrier (in micro level) function , which is not visible until the total damage occur in macro level to CD.

What are the available solutions and the limitations?

Keeping the hands safe from outward hazards (biological, chemical or mechanical) was the past requirement, the trend is that keeping a Hand health is a major concern. And requirement of solution providing such has been a trend combining in the current product structure.

Use of absorbent to help protect the skin from overhydration due to the discharge of body fluids remaining on the skin surface. By reducing the excessive discharge buildup that forms a moisture film on the skin, modern absorbent technologies have significantly improved the level of skin dryness, with demonstrable skin benefits trends in water vapor-permeable technologies have enabled their inclusion into disposable ‘breathable’ absorbent articles (Fig 08).

With modern absorbent technologies the impact of body fluids in direct skin contact is short-term and transient due to their rapid absorption and effective containment.

As there been much studies and glove use has been a century old experience, solution providers have given various of methods and possibilities though-out such as,

1. Providing pre-ointments prior to wearing of gloves, to prevent the over-hydration and minimize the perspiration – this is a limited application exampel in surgical not praticle for other apllciations (for example industrial) and some sensitive skin coinditons are prone to such onitments.

2. Powdered coating in the protective wear – sensitive skin condtions are prone to be affected and limtiation on some clean room conditions or low reside required conditions.

3. Wearign mositure absorbing linning bitween the imprevious barrier and skin example: Cotton liner, found to be effective for reducing the ICD condition and recommende by some legislations – practicality toward high flexibility/dextirity required task is limited.

4. Thicker absorbing linning coated in protective wear – Limited toward indutrial applications requiring thicker protection – flexibility/dextirity limitation.

5. Cotton flocking coated on the protective wear – effective for industrial applications and some medical applications – loos of flocking and limitation toward cleanroom condtions and low residue conditions. Some sensitive skin may have effects by this coating.

6. Vapour-permeable protective wearing – effectiveness is high – but due to even of micro level permeability there is limtiations for higher hazard contions to accomated in Indutrial applcations.