Effects of Occlusion on the Skin of Atopic Dermatitis Patients

Kristen Kobaly; Ally-Khan Somani; Thomas McCormick; Susan T. Nedorost

Disclosures

Dermatitis. 2010;21(5):255-261. 

In This Article

Abstract and Introduction

Abstract

Background: Atopic dermatitis (AD) may be exacerbated by occlusion from items such as occlusive gloves or textiles, especially if the occlusion is removed suddenly, creating a steep humidity gradient. Most previous studies of occlusion have focused on normal skin. Occlusion has been shown to be beneficial in psoriatic skin, but many atopic patients complain of increased inflammation after occlusion.
Objective: To evaluate the response of noninflamed AD skin to occlusion.
Methods: Six patients with AD were patch-tested with occlusive polyethylene wrap and sodium lauryl sulfate (SLS) in standard Finn Chambers taped to noninflamed skin of the back. Cytokine and chemokine messenger ribonucleic acid (mRNA) for interleukin-8 (IL-8), interleukin-1 alpha (IL-1α), and interleukin-1 receptor antagonist (IL-1RA), as well as the 18S rRNA housekeeping gene, was obtained via tape-stripping the skin and measured using quantitative real-time polymerase chain reaction. We also measured transepidermal water loss after removal of occlusion.
Results: Polyethylene occlusion alone with abrupt removal induced IL-8 and IL-1α levels similar to or exceeding that of SLS. IL-1RA was up-regulated by SLS and occlusion, with SLS showing a stronger response.
Conclusion: Removal of occlusion with polyethylene film up-regulates the inflammatory cytokines IL-8, IL-1α, and IL-1RA in patients with AD. This may explain the worsening of AD with the use of occlusive gloves, athletic equipment, and fabrics.

Introduction

Occlusion can be beneficial in inflammatory skin disease such as psoriasis but may be detrimental in atopic dermatitis. Filaggrin deficits in atopic dermatitis make skin more likely to fissure when a steep humidity gradient is present after the rapid removal of occlusion; defects in innate immunity make bacterial colonization more likely in atopic skin, and occlusion worsens bacterial proliferation as well.

Patients with atopic dermatitis differ from normal or psoriatic patients in their clinical tolerance of occlusion. In our experience, atopic patients complain more of itching from tape occlusion associated with patch testing and experience flares of dermatitis in areas of occlusion, such as the area under soccer shin guards or covered by occlusive footwear or fabrics. Occupation-related hand dermatitis due to "wet work" has long been recognized as more common among atopic patients; surfactants are often blamed, but a study on pig skin implicated water itself as the most likely culprit.[1] We studied the effect of polyethylene occlusion on normal skin of patients with atopic dermatitis. Occlusive gloves, dressings, and fabrics are all relevant clinical examples of occlusion in the cutaneous environment.

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