Relief of Dermal Sensitivity Caused by Latex Gloves

Allan S. Deutsch, D.M.D., F.A.C.D.
Relief of Dermal Sensitivity Caused by Latex Gloves

Allan Deutsch

INCE THE ADVENT of universal precautions against infection has led to the routine wearing of latex operating gloves, concern regarding hypersensitivity reactions to these gloves has been increasing. This concern can be seen in the numerous articles now being published on this topic. In November 1994, Gordon Christensen’s CRA newsletter reported on a survey of dermal sensitivity. Twelve percent of 28,858 respondents reported experiencing some type of reaction to various types of operating gloves. Latex gloves were by far the most common cause of problems, but vinyl and nitrile rubber also caused some problems. The most common reactions were

itching, redness on the contact area, or both
dry skin on the contact area
cracking skin on the contact area

What Causes “Dry” Skin?

IN HIS CLASSIC STUDY, Blank showed that lack of water, not lack of oil, was the primary cause of dry skin, proving that the softness and flexibility of the stratum corneum was a direct function of the moisture in it. Blank concluded that cornified epithelium required 10 percent to 20 percent water content to feel and look “normal,” since water was the most effective “plasticizer” for cornified tissue. Blank emphasized that neither an externally applied oil, nor the “natural” oils, can keep the stratum flexible without the aid of water.

FIGURE 2: Layers of the epithelium.

Flesch in a discussion of the chemical basis of emollient in the horny layers, found evidence that the skin contains hydrophilic nitrogenous substances as well as other hydrophilic substances, which enhance the ability of the skin to hold water. When these substances are extracted from the skin, its ability to hold moisture is greatly diminished. In addition, in various skin conditions associated with scaling, the scales appear to have lesser amounts of these substances as well as a low capacity to bind moisture.

FIGURE 3: Structure of the skin.

FIGURE 1: Cracking of the skin due to dryness.

Recent work has brought to light a number of interesting facts concerning hydration of the stratum corneum. For example, it has been found that the stratum corneum contains water-soluble compounds responsible for the wetability, water-holding, and water-absorbing capacities of this tissue, which are called collectively the “natural moisturizing factor” of the skin, or NMF. Thus, the stratum corneum contains 58 percent keratin, 11 percent lipid, and 30 percent water-soluble NMF. Table 1 gives the chemical composition of NMF.
The presence of NMF in the stratum corneum serves a triple purpose:

It picks up moisture through its hygroscopic properties.
It lowers the surface tension of the skin surface, overcoming the normal water repellency of the keratin.
It will absorb liquid water present on the skin surface from perspiration or from outside sources.

We can conclude that NMF regulates the water content of the stratum corneum.
Striase concludes, from all of the data disclosed, that an occlusive agent alone would not perform as the ideal moisturizer, nor would a hygroscopic moisturizer alone act as the ideal moisturizer. However, a proper balance of the two might achieve the desired result. Thus the “ideal” moisturizer should have the following properties:

It must regulate and maintain the water content of the stratum corneum, but not to such a degree as to induce superhydration.
Its effectiveness should be independent of environmental changes.
Its continued application must not cause damage to the stratum corneum by the removal of or interference with the natural moisturizers present therein.
It must be nonirritating and nonsensitizing.
It must be stable in cosmetic formulations.
It must be economical and readily available.

At present, it is not certain which of the various components of MNF plays the most significant role. In the past, urea was apparently considered important, resulting in a plethora of dry skin remedies containing urea.
Using in vitro experiments, Hellgren and Larson concluded that:

The long-term use of urea-containing dermatologic preparations may “reduce” and damage the horny layer of the skin.
Sodium chloride does not damage the skin.
Sodium chloride has twice the water-binding capacity of urea and thus should be considered a superior moisturizing agent.

It has long been known that the presence of sodium chloride in water tends to retard its vaporization. The use of sodium chloride by Ljungstrom in 1941 predates the employment of urea for dry skin and ichthyosis by Rattner in 1943. Ljungstrom achieved good results in a patient with ichthyosis using baths containing 3 percent salt water, followed by inunction of 10 percent sodium chloride in lanolin.
Gordon, employing Ljungstrom’s regimen in one case of ichthyosis vulgaris and in another of ichthyosis hystrix, reported that both responded dramatically. He claimed that the patient with ichthyosis hystrix, who looked like a “porcupine man,” was “rehumanized.”
Despite such glowing reports, sodium chloride ointments were not employed extensively because patients were reluctant to consent to the use of the thick, greasy ointments then available.

“Dead Sea Salt” Cream for Dry Skin (Glove’n Care™)

BECAUSE topical preparations containing urea were not particularly effective in some patients with dry skin and also sometimes caused stinging, burning sensations, we undertook an investigation of the use of creams containing sodium chloride, which have been shown to be more effective and less irritating than creams containing urea.
    Without understanding the exact physiology of healing, we do know that the Ancients discovered the beneficial effects of the waters of the Dead Sea more than four thousand years ago. These benefits included a therapeutic improvement in such skin disorders as psoriasis and eczema as well as an enhancement of normal skin. The Dead Sea was actually the site of a major cosmetic industry in Ancient times. Queen Cleopatra enjoyed the benefits of Dead Sea cosmetics so much that she persuaded Mark Antony to establish control over portions of the sea and then give them to her as a gift.
    Because Europe was the focal point of western culture, the Dead Sea remained for a long period obscure and almost unknown in the backwaters of a provincial people. It was not until the formation of the modern state of Israel that the waters of the Dead Sea became recognized worldwide for their therapeutic value. Today more than 600,000 tourists travel to the Dead Sea annually. In fact, for those traveling from Northern Europe, a trip to the Dead Sea is a recognized medical expense.
Goldberg and Sagher state that the Dead Sea has no drainage and therefore contains a very high concentration (up to 30 percent) of minerals, including sodium, potassium, magnesium, calcium (and halogens), chlorine, bromine, and “others.”
    At the suggestion of Essential Dental Systems, a processed and purified concentrate of Dead Sea water (5 percent) was incorporated into a water-based emulsion. The emulsion was water-based so that it would not compromise the integrity of the latex glove or interfere with adhesive dentistry. It is of interest that Glove’n Care hand cream contains all of the minerals present in NMF (see Table 1).
    From theoretical and practical viewpoints, Glove’n Care hand cream has many of the virtues that Striase enumerated as the properties of an ideal moisturizer:

It contains an effective hygroscopic moisturizer: water of high saline content.
It does not cause burning, stinging, or other unpleasant sensations and is well tolerated on the lips and skin.
It is nonsensitizing and nonirritating and does no damage to the stratum corneum, even after repeated applications.
By hydrating the stratum corneum, it quite effectively relieves the scaliness, dryness, and pruritus associated with dry skin, with resultant softening and increased pliability of the skin.
It is stable chemically and physically for long periods of time, requires no preservatives, and is free of perfume, thus lessening the possibility of allergic contact dermatitis from such added ingredients.
It is inexpensive.
It seems to prove that the dermatologists of “the good old days” were correct when they claimed that sodium chloride is an excellent “moisturizer.”
It contains the electrolytes present in NMF-sodium, chloride, calcium, potassium and magnesium.
It contains a high concentration of sodium, which possibly enhances the moisturizing effect of PCA in NMF, since it is sodium PCA, not PCA alone that is hygroscopic.

References

Blank JH: Factors which influence the water content of the skin. J Invest Dermatol 18: 433, 1952 [BACK]
Flesch P: Chemical basis of emollient function in horny layers. Proc Sci Sect TGA 40: 12, 1963 [BACK]
Flesch P, Jackson-Esoda EC: Deficient water-binding in pathologic horny layers. J Invest Dermatol 28: 5, 1957 [BACK]
Striase S J: The search for the ideal moisturizer. Cosmet Perfum 89: 57, 1974 [BACK]
Hellgren L, Larson K : On the effect of urea on human epidermis. Dermatologica 149: 289, 1974 [BACK]
Ljungstrom C E: A simple and effective treatment of ichthyosis. Acta Med Scand 108: 98, 1941 [BACK]
Gordon H: Treatment of ichthyosis. Arch Dermatol 52: 178, 1945 [BACK]
Goldberg L H, Sagher F: Psoriasis treatment at the Dead Sea. Cutis 16: 61 1975 [BACK]

September-October 2002

Do not use Septocaine™ on patients who are allergic to sulfur medication. The sulfur compound from the preservative in Septocaine is different from the sulfur compound in other anaesthetic solutions.
Septocaine contains sodium metabisulfite, a sulfite that may cause allergic reactions including asthmatic episodes in susceptible people.

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