Why Use AproDerm^®?

Irritants

An irritant is a substance that causes inflammation to the body in a non-immune way and can affect anyone who comes into contact with sufficient amounts of it for long enough, however those with atopic eczema are more sensitive to irritants¹. The skin can react straight away (immediate response) or after a period of repeated exposure and examples of irritants include SLS, water and detergents¹. Irritants remove moisture (by affecting Natural Moisturising Factor) and oils from the outer skin layer allowing pathogens, irritants and allergens to enter the skin causing inflammation and further damage^1,2.

Sensitisers

A skin sensitiser is a chemical that will cause an allergic reaction when exposed to the skin and unlike an irritant it will only affect those who are allergic to it³. The initial exposure will not cause a reaction but continued exposure to the sensitiser can cause the skin to react to it and once a person has been sensitised to a product, contact with even a small amount of it will cause a reaction.

Many topical products, including emollients, contain excipients in addition to the active ingredient(s). These excipients have various useful roles:

Thickening agents – to thicken the product.
Emulsifiers – an emulsifier allows oil and water to mix and, by reducing the surface tension, has a stabilising effect on the emulsion.
Preservatives – prevent microbial spoilage of the product by killing off or inhibiting the growth of micro-organisms.
Buffers – maintain the pH environment of the product throughout its shelf life.
Fragrances – provide a distinctive odour to the product which can be used to mask the smell of unpleasant ingredients within the product.

However, certain excipients are known irritants and / or sensitisers. Such excipients can aggravate already sensitive skin causing reactions that result in the development of skin inflammation and itchiness. This would result in your patient scratching causing further damage, exacerbating the itch-scratch cycle and preventing the skin from repairing itself. Symptoms typically seen include skin which can be red, swollen, blistered, dry, thickened, intensely itchy and cracked depending on whether the reaction is acute or chronic². The two conditions, allergic and irritant dermatitis, may co-exist.

This is why the complete AproDerm^® Range has been developed to be free from the following common irritants and sensitisers:

Hence it can be considered that the risk of a reaction to a patient will be greatly reduced thus aiding compliance. To find out more about the common irritants and sensitisers that the AproDerm^® Range is free from click on the relevant box below:

¹Ec.europa.eu. (2012). Health and safety: Skin irritants - SAMANCTA. [online] Available at: http://ec.europa.eu/taxation_customs/dds2/SAMANCTA/EN/Safety/SkinIrritants_EN.htm [Accessed 18 Apr. 2018] | ²Oshwiki.eu. (2017). Irritants and allergens: OSHwiki. [online] Available at: https://oshwiki.eu/wiki/Irritants_and_allergens [Accessed 18 Apr. 2018]. | ³ Skin Sensitisers. (2003). 40th ed. [ebook] Belgium: European Agency for Safety and Health at Work. Available at: https://osha.europa.eu/en/tools-and-publications/publications/factsheets/40 [Accessed 18 Apr. 2018].

Sodium Lauryl Sulfate (SLS)

A chemical commonly found in numerous cosmetic products including toothpastes, shampoos, soaps, shaving creams and hair products¹.
SLS is a detergent, emulsifier and surfactant which means that it allows oil and water to mix, reduces surface tension, creates foam and cleans².
In emollients SLS is used as an emulsifier (allows oil and water to mix) and as a thickening agent to allow the product to be applied easily to the skin³.
SLS is a well recognised skin irritant and has been shown to decrease natural moisturising factor (NMF) production which means more moisture can be lost from the skin causing it to dry out and making it easier for allergens to enter and cause irritation⁴.
In 2010 the results of a study on the effects of aqueous cream on the outer skin layer showed that skin that aqueous cream had been applied to was 12% thinner and had more transepidermal water loss (about 20%) compared to skin that wasn’t treated with aqueous cream and the researchers linked this to SLS⁵.

Parabens

Parabens are widely used in cosmetic products such as make-up, moisturisers, toothpastes, nappy creams and hair care products, as well as in some foods and drugs¹.
A group of chemicals that have preservative qualities and protect against microbial growth due to fungi, bacteria and yeast, so prolonging the shelf-life of a product and preventing the transfer of microbial organisms onto a patient’s skin².
Common examples of parabens include methylparaben, propylparaben and butylparaben although on product labels they may be listed as hydroxybenzoates¹.
Parabens for the vast majority of the population with normal skin are non-irritating and non-sensitising however paraben sensitisation can occur following repeated low level use (such as from the amount found in emollients) with most cases involving broken or damaged skin³.
In a study of 121,247 people 1.33% had a reaction to parabens while patients with chronic dermatitis are at an increased risk of parabens sensitisation⁴. Hence patients with severe eczema and allergic contact dermatitis may benefit from a parabens free treatment regime⁵.
In March 2011, following growing concerns over parabens, Denmark banned propyl and butyl parabens and their salts from cosmetic products that were used in children under the age of three⁶.
Another study involving 350 Norwegian women found that heavy users of cosmetic products had high levels of parabens in their blood which is worrying as parabens can disrupt hormonal balance in the body and so may impact on fertility⁷.

Triethanolamine (TEA)

Triethanolamine (TEA) can be found in up to 40% of products on the market including emollients, cosmetics, perfumes, skin creams, gels and hair dyes^1,2.
Triethanolamine is commonly used as a pH buffer and an emulsifier, allows water and oil to mix³.
An organic compound which is a by-product of two highly toxic chemicals, ethylene oxide and ammonia².
Triethanolamine is recognised as a skin sensitiser by MIMS⁴ and can cause allergic reactions, dry out skin and hair as well as irritate the eyes^2,5. Over extended time, TEA can cause damage to skin in the form of blisters, burning sensation or hives³.
In Germany, a study on the skin sensitizing properties of ethanolamines found that 323 patients out of 85,098 tested positive⁶.
It is recommended by the FDA that the concentration of TEA in a single product must not be above 5%³ and should not be in a product that contains N-nitrosating agents as a mixture of these substances can form carcinogenic products¹.

Benzyl Alcohol

Benzyl alcohol is found in a variety of products ranging from emollients, cosmetics, wound dressings, medicines, soaps through to household and cleaning products¹.
Benzyl alcohol is an aromatic chemical compound that is a fatty alcohol (and not an actual alcohol/spirit). It is used in emollients as a pH adjuster, preservative or as solubilising agent^2,3.
Known by various names such as a-hydroxytoluene, phenylcarbinol, benzylic alcohol and phenylmethyl alcohol.
Benzyl alcohol toxicity is linked to its accumulation in the individual to a toxic level and it is believed that this accumulation, especially in pre-term neonates, is the cause of the gasping baby syndrome. Characterized by respiratory distress ("gasping"), metabolic acidosis, haematologic abnormalities and death, it was first discovered in 1982 following a series of deaths or severe illnesses in neonates which were linked to intravenous flush solutions and medications containing benzyl alcohol^4,5.
As there has been no clear study to indicate the safety of benzyl alcohol at ‘low-levels’, the FDA advised that products for infants should be benzyl alcohol free. The EMA guideline on the use of benzyl alcohol and benzoic acid states that benzyl alcohol must not be used in pre-term and full-term neonates, also it’s not recommended for children under 3 years^5,6.
Benzyl alcohol poisoning can result through oral, dermal, inhalation and ocular routes⁷.
Benzyl alcohol use in adults has been associated with hypersensitivity reactions, including contact dermatitis and nausea. It has been found to be irritating to the skin at levels 3% or more in adults. Several studies show benzyl alcohol is an irritant in adults causing not only skin reactions but also causing bronchitis (1995)^5,7,8.

Fragrances

Fragrances can be found in emollients, cosmetics, perfumes, creams, wet wipes, toilet paper and washing powder¹.
Fragrances are added to many products including emollients to make them more appealing and to mask any unpleasant smells that may be a necessary part of the product. These fragrances can be natural or synthetic and are thought to affect the user’s perception of the product and contribute to skin feel and acceptability in using the product.
Fragrances, however, are one of the most frequent causes of allergic contact dermatitis from cosmetic products and the second most common cause of positive patch test results after nickel, with certain fragrance chemicals e.g. isoeugenol, cinnamal and citral being quite potent sensitisers².
Approximately 1.0% – 4.2% of the population are sensitised to fragrance materials whilst in those with eczema this figure can be as high as 14%. Fragrances will often exacerbate existing dermatitis so a treatment that is fragrance free may be beneficial in those with already sensitive skin^3,4.
The American Contact Dermatitis Society voted fragrance as Allergen of the Year in 2007⁵ in an attempt to highlight both its abundance in everything from cosmetics and cleaning products to foods and medications as well as it’s potential to be an allergenic substance in the development of dry skin conditions.
To test for fragrance allergies a person is tested with a mix of fragrances – there are two types of fragrance mixes Mix I and II, Mix I contains 8 different fragrances and Mix II consists of 6. A positive response indicates a fragrance allergy to one or more of the fragrances in the mix and it is advised that those affected should avoid products containing perfumes and stick to fragrance free products⁶.

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Why Use AproDerm®?