Barrier Cream Cloth Efficacy and Prevention of Transepidermal Water Loss-An Important Consideration in Product Selection

The aim of this study is to evaluate evidence for prevention of transepidermal water loss (TEWL) by comparison of 4 dimethicone containing barrier cream cloth products. Methods: Thirty adult volunteers of mixed sex, age, and race had daily application of each product to a 1.5 in. x 1.5 in. area of skin where Artificial Urine at pH 10.28 was applied for 7 days in random assignment to sites using an occluded patch (Finn Chamber on Scanpor tape). Sodium Lauryl Sulfate 1%, was applied in a similar manner as the positive control.  A negative control (no chemical irritant application) also was randomly assigned and measured. All test sites were scored by blinded, trained, visual assessors for evidence of irritation, including erythema, papules, edema and vesicles. Results: After daily applications of the Artificial Urine, only one product showed no net skin water loss  (TEWL= g/hr/m²) over the 7-day study (statistically significant using Tukey pairwise comparison of test products, 95% confidence means). Discussion: Evidence gained from this testing further demonstrates that skin barrier efficacy is dependent on the entire final product formulation and specifically does NOT necessarily correlate with the percentage concentration of dimethicone. A  product with inadequate skin barrier efficacy is more likely to not allow achievement of institutional compliance with IAD Guidelines, and, of course, less likely to serve the needs of the patient. Despite product variability in dimethicone concentration, it proved to be an independent determinant for skin barrier efficacy. Conclusions: This study underscores the importance of evaluating product performance characteristics for similarly marketed barrier products. It remains for the practitioner and the user to be able to determine that the selected product provides the expected skin barrier effectiveness, a product characteristic that is not communicated to a user by simply reading the concentration of ingredients on the product label.