Introduction: Skin tissue is frequently exposed to various irritant substances in the workplace, particularly in wet work, which can lead to the development of occupational contact dermatitis. ‘Barrier' creams (BCs) are well known, and their applications are still the subject of many studies and controversies. Methods: We searched all controlled trials investigating BCs against cutaneous irritants in humans published between 1956 and December 2014 from MEDLINE, PubMed, reference lists and existing reviews. Results: Thirty-nine studies about the effects of BCs against skin irritants in humans were selected. Among these, 27 trials in healthy volunteers were found to show many differences with regard to BCs and irritants used, their quantities, test locations, procedures and assessment methods. Finally, 14 patch test trials assessed by clinical scoring and evaporimetry emerged. Although the findings were generally positive, only few findings could be cross-checked from all the data, and vehicles seem to be as effective as BCs. Conclusion: Although this review highlights the poor quality and the lack of standardization of most studies, BCs seem to have protective effects against irritants. Further well-designed, adequately powered randomized controlled trials with clinical and biophysical assessments are required.

Keywords:
Barrier cream, Skin protection, Workplace, Irritant, Review
1.
Kütting B, Weistenhöfer W, Baumeister T, Uter W, Drexler H: Current acceptance and implementation of preventive strategies for occupational hand eczema in 1,355 metalworkers in Germany. Br J Dermatol 2009;161:390-396.
2.
Saary J, Qureshi R, Palda V, DeKoven J, Pratt M, Skotnicki-Grant S, Holness L: A systematic review of contact dermatitis treatment and prevention. J Am Acad Dermatol 2005;53:845-855.
3.
Belsito DV: Occupational contact dermatitis: etiology, prevalence, and resultant impairment/disability. J Am Acad Dermatol 2005;53:303-313.
4.
Alvarez MA, Brown LH, Brancaccio RR: Are barrier creams actually effective? Curr Allergy Asthma Rep 2001;1:337-341.
5.
Behroozy A, Keegel TG: Wet-work exposure: a main risk factor for occupational hand dermatitis. Saf Health Work 2014;5:175-180.
6.
Teichmann A, Jacobi U, Waibler E, Sterry W, Lademann J: An in vivo model to evaluate the efficacy of barrier creams on the level of skin penetration of chemicals. Contact Dermatitis 2006;54:5-13.
7.
Del Rosso JQ: Incorporation of a barrier protection cream in the management of chronic hand dermatitis: focus on data supporting an established hand protectant formulation and modifications designed to assist in barrier repair. J Clin Aesthet Dermatol 2014;7:40-48.
8.
Zhai H, Maibach HI: Barrier creams - skin protectants: can you protect skin? J Cosmet Dermatol 2002;1:20-23.
9.
Zur Mühlen A, Klotz A, Allef P, Weimans S, Veeger M, Thörner B, Eichler JO: Using skin models to assess the effects of a pre-work cream. Methodological aspects and perspective of the industry. Curr Probl Dermatol 2007;34:19-32.
10.
Corazza M, Minghetti S, Bianchi A, Virgili A, Borghi A: Barrier creams: facts and controversies. Dermatitis 2014;25:327-333.
11.
Mahmoud G, Lachapelle JM, Van Neste D: Histological assessment of skin damage by irritants: its possible use in the evaluation of a ‘barrier cream'. Contact Dermatitis 1984;11:179-185.
12.
Zhai H, Maibach HI: Protection from irritants. Curr Probl Dermatol 2007;34:47-57.
13.
Kresken J, Klotz A: Occupational skin-protection products - a review. Int Arch Occup Environ Health 2003;76:355-358.
14.
Bauer A, Schmitt J, Bennett C, Coenraads PJ, Elsner P, English J, Williams HC: Interventions for preventing occupational irritant hand dermatitis. Cochrane Database Syst Rev 2010;6:CD004414.
15.
Guillemin M, Murset JC, Lob M, Riquez J: Simple method to determine the efficiency of cream used for skin protection against solvent. Br J Ind Med 1974;31:310-316.
16.
Lauwerys RR, Dath T, Lachapelle JM, Buchet JP, Roels H: The influence of two barrier creams on the percutaneous absorption of m-xylene in man. J Occup Med 1978;20:17-20.
17.
Fischer T, Rystedt I: Skin protection against ionized cobalt and sodium lauryl sulphate with barrier creams. Contact Dermatitis 1983;9:125-130.
18.
Lodén M: The effect of 4 barrier creams on the absorption of water, benzene, and formaldehyde into excised human skin. Contact Dermatitis 1986;14:292-296.
19.
Blanken R, Nater JP, Veenhoff E: Protective effect of barrier creams and spray coatings against epoxy resins. Contact Dermatitis 1987;16:79-83.
20.
Marks R, Dykes PJ, Hamami I: Two novel techniques for the evaluation of barrier creams. Br J Dermatol 1989;120:655-660.
21.
Nouaigui H, Antoine JL, Masmoudi ML, Van Neste DJ, Lachapelle JM: Études invasives et non invasives du pouvoir protecteur d'une crème siliconée et de son excipient vis-à-vis de l'irritation cutanée induite par le laurylsulfate de sodium. Ann Dermatol Vénéréol 1989;116:389-398.
22.
Frosch PJ, Kurte A, Pilz B: Efficacy of skin barrier creams. III. The repetitive irritation test (RIT) in humans. Contact Dermatitis 1993;29:113-118.
23.
Frosch PJ, Kurte A: Efficacy of skin barrier creams. IV. The repetitive irritation test (RIT) with a set of 4 standard irritants. Contact Dermatitis 1994;31:161-168.
24.
Treffel P, Gabard B, Juch R: Evaluation of barrier creams: an in vitro technique on human skin. Acta Derm Venereol 1994;74:7-11.
25.
Marks JG Jr, Fowler JF Jr, Sheretz EF, Rietschel RL: Prevention of poison ivy and poison oak allergic contact dermatitis by quaternium-18 bentonite. J Am Acad Dermatol 1995;33:212-216.
26.
Schlüter-Wigger W, Elsner P: Efficacy of 4 commercially available protective creams in the repetitive irritation test (RIT). Contact Dermatitis 1996;34:278-283.
27.
Zhai H, Maibach HI: Effect of barrier creams: human skin in vivo. Contact Dermatitis 1996;35:92-96.
28.
De Fine Olivarius F, Brinch Hansen A, Karlsmark T, Wulf HC: Water protective effect of barrier creams and moisturizing creams: a new in vivo test method. Contact Dermatitis 1996;35:219-225.
29.
Baur X, Chen Z, Allmers H, Raulf-Heimsoth M: Results of wearing test with two different latex gloves with and without the use of skin-protection cream. Allergy 1998;53:441-444.
30.
Fartasch M, Schnetz E, Diepgen TL: Characterization of detergent-induced barrier alterations - effect of barrier cream on irritation. J Investig Dermatol Symp Proc 1998;3:121-127.
31.
Elsner P, Wigger-Alberti W, Pantini G: Perfluoropolyethers in the prevention of irritant contact dermatitis. Dermatology 1998;197:141-145.
32.
Wigger-Alberti W, Rougier A, Richard A, Elsner P: Efficacy of protective creams in a modified repeated irritation test. Methodological aspects. Acta Derm Venereol 1998;78:270-273.
33.
Zhai H, Willard P, Maibach HI: Evaluating skin-protective materials against contact irritants and allergens. An in vivo screening human model. Contact Dermatitis 1998;38:155-158.
34.
Patterson SE, Williams JV, Marks JG Jr: Prevention of sodium lauryl sulfate irritant contact dermatitis by Pro-Q aerosol foam skin protectant. J Am Acad Dermatol 1999;40:783-785.
35.
Zhai H, Brachman F, Pelosi A, Anigbogu A, Ramos MB, Torralba MC, Maibach HI: A bioengineering study on the efficacy of a protectant lotion in preventing SLS-induced dermatitis. Skin Res Technol 2000;6:77-80.
36.
Schnetz E, Diepgen TL, Elsner P, Frosch PJ, Klotz AJ, Kresken J, Kuss O, Merk H, Schwanitz HJ, Wigger-Alberti W, Fartasch M: Multicentre study for the development of an in vivo model to evaluate the influence of topical formulations on irritation. Contact Dermatitis. 2000;42:336-343.
37.
Sun Q, Tran M, Smith B, Winefordner D: In-situ evaluation of a barrier-cream performance on human skin using laser-induced breakdown spectroscopy. Contact Dermatitis 2000;43:259-263.
38.
Schliemann-Willers S, Wigger-Alberti W, Elsner P: Efficacy of a new class of perfluoropolyethers in the prevention of irritant contact dermatitis. Acta Derm Venereol 2001;81:392-394.
39.
Wöhrl S, Kriechbaumer N, Hemmer W, Focke M, Brannath W, Götz M, Jarisch R: A cream containing the chelator DTPA (diethylenetriaminepenta-acetic acid) can prevent contact allergic reactions to metals. Contact Dermatitis 2001;44:224-228.
40.
Chilcott RP, Jenner J, Hotchkiss SAM, Rice P: Evaluation of barrier creams against sulphur mustard. I. In vitro studies using human skin. Skin Parmacol Appl Physiol 2002;15:225-235.
41.
Van der Bijl P, Gareis A, Lee H, van Eyck AD, Stander IA, Cilliers J: Effects of two barrier creams on the diffusion of benzo[a]pyrene across human skin. S Afr Dent J 2002;57:49-52.
42.
Wigger-Alberti W, Spoo J, Schliemann-Willers S, Klotz A, Elsner P: The tandem repeated irritation test: a new method to assess prevention of irritant combination damage to the skin. Acta Derm Venereol 2002;82:94-97.
43.
Lati E, Gasser P, Lefeuvre L, Matta AM, Gougerot A: Study of the protective effects of a barrier cream preventing skin penetration of nickel nitrate. Nouv Dermatol 2004;23:208-213.
44.
Elsner P: Protection from combination exposure. Curr Probl Dermatol 2007;34:111-119.
45.
Rieger T, Teichmann A, Richter H, Schanzer S, Sterry W, Lademann J: Evaluation of barrier creams - introduction and comparison of 3 in vivo methods. Contact Dermatitis 2007;56:347-354.
46.
Korinth G, Lüersen L, Schaller KH, Angerer J, Drexler H: Enhancement of percutaneous penetration of aniline and o-toluidine in vitro using skin barrier creams. Toxicol In Vitro 2008;22:812-818.
47.
Slade HB, Fowler J, Draelos ZD, Reece BT, Cargill DI: Clinical efficacy evaluation of a novel barrier protection cream. Cutis 2008;82:21-28.
48.
Lembo S, Lembo C, Lo Conte V, Gallo L, La Bella S, Martellotta D, Ayala F: In vivo evaluation of a Poly-2p barrier cream protective effect. G Ital Dermatol Venereol 2010;145:703-708.
49.
Roure R, Lanctin M, Nollent V, Bertin C: Methods to assess the protective efficacy of emollients against climatic and chemical aggressors. Dermatol Res Pract 2012;2012:864734.
50.
Schliemann S, Kleesz P, Elsner P: Protective creams fail to prevent solvent-induced cumulative skin irritation - results of a randomized double-blind study. Contact Dermatitis 2013;69:363-371.
51.
Schliemann S, Petri M, Elsner P: Preventing irritant contact dermatitis with protective creams: influence of the application dose. Contact Dermatitis 2014;70:19-26.
52.
Sadhra SS, Kurmi OP, Mohammed NI, Foulds IS: Protection afforded by controlled application of a barrier cream: a study in a workplace setting. Br J Dermatol 2014;171:813-818.
53.
Chilcott RP, Dalton CH, Ashley Z, Allen CE, Bradley ST, Maidment MP, Jenner J, Brown RF, Gwyther RJ, Rice P: Evaluation of barrier creams against sulphur mustard. II. In vivo and in vitro studies using the domestic white pig. Cutan Ocul Toxicol 2007;26:235-247.
54.
Boman A, Mellström G: Percutaneous absorption of 3 organic solvents in the guinea pig. III. Effect of barrier creams. Contact Dermatitis 1989;21:134-140.
55.
Wigger-Alberti W, Maraffio B, Wernli M, Elsner P: Self-application of a protective cream. Pitfalls of occupational protection. Arch Dermatol 1997;133:861-864.
56.
Schliemann S, Petri M, Elsner P: How much skin protection cream is actually applied in the workplace? Determination of dose per skin surface area in nurses. Contact Dermatitis 2012;67:229-233.
57.
Duca PG, Pelfini G, Ferguglia G, Settimi L, Peverelli C, Sevosi I, Terzaghi G: Efficacia dell'uso di creme-barriera nel prevenire affezioni dermatologiche in lavoratori delle tintostamperie: risultati di una sperimentazione randomizzata. Med Lav 1994;85:231-238.
58.
Kütting B, Uter W, Baumeister T, Schaller B, Weistenhöfer W, Drexler H: Non-invasive bioengineering methods in an intervention study in 1,020 male metal workers: results and implications for occupational dermatology. Contact Dermatitis 2010;62:272-278.
59.
Kütting B, Baumeister T, Weistenhöfer W, Pfahlberg A, Uter W, Drexler H: Effectiveness of skin protection measures in prevention of occupational hand eczema: results of a prospective randomized controlled trial over a follow-up period of 1 year. Br J Dermatol 2010;162:362-370.
60.
Winker R, Salameh B, Stolkovich S, Nikl M, Barth A, Ponocny E, Drexler H, Tappeiner G: Effectiveness of skin protection creams in the prevention of occupational dermatitis: results of a randomized, controlled trial. Int Arch Occup Environ Health 2009;82:653-662.
61.
De Paepe K, Hachem JP, Vanpee E, Goossens A, Germaux MA, Lachapelle JM, Lambert J, Matthieu L, Roseeuw D, Suys E, Van Hecke E, Rogiers V: Beneficial effects of a skin tolerance-tested moisturizing cream on the barrier function in experimentally elicited irritant and allergic contact dermatitis. Contact Dermatitis 2001;44:337-343.
62.
Frosch PJ, Schulze-Dirks A, Hoffmann M, Axthelm I, Kurte A: Efficacy of skin barrier creams. I. The repetitive irritation test (RIT) in the guinea pig. Contact Dermatitis 1993;28:94-100.
63.
Berndt U, Wigger-Alberti W, Gabard B, Elsner P: Efficacy of a barrier cream and its vehicle as protective measures against occupational irritant contact dermatitis. Contact Dermatitis 2000;42:77-80.
64.
Wang SM, Shih TS, Huang YS, Chueh MR, Chou JS, Chang HY: Evaluation of the effectiveness of personal protective equipment against occupational exposure to N,N-dimethylformamide. J Hazard Mater 2006;B138:518-525.
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