A barrier cream, also known as shielding lotion, is a topical formulation used in industrial applications and as a cosmetic to place a physical barrier between the skin and contaminants that may irritate the skin (contact dermatitis or occupational dermatitis). For hand care they are designed to protect against the harm from detergents and other irritants.
The efficacy of barrier creams remains disputed. They have not been demonstrated to be useful in treating hand eczema. A 2010 Cochrane review concluded that there was insufficient evidence to determine whether barrier cream could prevent occupational contact dermatitis. They are a poor substitute for protective clothing for workers. Gloves provide a greater protection than barrier creams. Some evidence suggests that improper barrier cream use could cause a harmful rather than a beneficial effect. Skin that has been moisturized by barrier cream may be more susceptible to irritation by sodium lauryl sulfate, which can permeate hydrated skin more easily due to its hydrophilia.
As early as 1965 the term shielding lotion was used. In 2005, the Internet marketing agency Expansion Plus began promoting the term shielding lotion in a highly successful campaign that relied on planting information in social media so that it would be picked up and spread virally.
To help prevent the spread of pathogens, health care providers are required to wash their hands frequently. Frequent hand washing can result in chronic damage termed irritant contact dermatitis which includes dryness, irritation, itching, and more seriously, cracking and bleeding. Irritant contact dermatitis is very common among nurses, ranging from 25% to 55%, with as many as 85% relating a history of having skin problems. The World Health Organization has considered the use of barrier creams and has found their efficacy to be "equivocal" and too expensive to be considered in health-care settings where resources are limited.
The Centers for Disease Control and Prevention found "Two recent randomized, controlled trials that evaluated the skin condition of caregivers demonstrated that barrier creams did not yield better results than did the control lotion or vehicle used. As a result, whether barrier creams are effective in preventing irritant contact dermatitis among health-care workers remains unknown."
The Great Ormond Street Hospital Manual of Children's Nursing Practices 2012 book found that "disposable nappies are effective in drawing fluid away from the skin and can be changed less frequently in the absence of stools, making regular application of barrier creams unnecessary in most children."
The efficacy of barrier creams remains disputed. They have not been demonstrated to be useful in treating hand eczema. According to the National Safety Council, "shielding lotions can keep the skin from drying out."
A 2002 review found "some reports indicate that inappropriate BC application might induce a deleterious rather than a beneficial effect." Skin that has been moisturized by barrier cream may be more susceptible to irritation by sodium lauryl sulfate, which can permeate hydrated skin more easily due to its hydrophilia. When handling hazardous molecules such as sodium hydroxide, ingredients in barrier cream could react and induce skin irritation. Barrier creams that contain petroleum jelly or certain oils may cause rubber or latex gloves to deteriorate.
Barrier preparations, which can be a cream, ointment or aerosol spray, often contain water-repelling substances such as silicone, zinc oxide, or dimethicone, sometimes as combinations such as Silon (dimethicone and zinc oxide).
Mechanism of action
The mechanism of barrier cream varies by product. Moisturizing barrier cream acts as a lubricating film on the skin to prevent depletion of water (transepidermal water loss) in the skin's outermost layer, the stratum corneum. This may have a protective effect against irritant contact dermatitis and allergic contact dermatitis, which often result from such depletion. These barrier creams can be classed as emollients (which prevent loss through a hydrophobic effect), humectants (which absorb water from the dermis and environment due to hygroscopy), or hydrating agents (which both moisturize the skin and maintain its water content).
Other barrier creams are intended to protect the skin from some external agents, although they are not sufficient to provide a complete barrier. These creams may contain substances such as zinc oxide, talc or kaolin to layer over the skin.
Barrier creams have been used in industry to protect workers' skin from the contaminants encountered in occupations such as nurses, hairdressers, employees in the food processing industry, cleaners, metal workers, printers, bricklayers etc. In this application a barrier cream may also be water repellent but may also need to repel certain solvents present in mineral oils, gasoline, paints, lubricants and ink. China clay or kaolinite can be added to physically block the skin's pores.
A 2010 Cochrane review concluded that there was insufficient evidence to determine whether barrier cream could prevent irritant contact dermatitis in the workplace. They are a poor substitute for protective clothing for workers. Gloves provide a greater protection than barrier creams.
As early as 1965 the term shielding lotion was used. In 2005, the Internet marketing agency Expansion Plus began promoting the term shielding lotion in a highly successful campaign that relied on planting information in social media so that it would be picked up and spread virally. The basic principle was to place articles on the skinmdnatural.com website that appeared to be reviews, and then distribute links via news sites and press releases, so that the purported reviews would be replicated elsewhere.
- Zhai H, Maibach HI (2002). "Barrier creams--skin protectants: can you protect skin?". J Cosmet Dermatol 1 (1): 20–3. PMID 17134447.
- Safety & Health: SH. 172-173 (Digitized June 1, 2010 ed.). The Council. 2005.
- Bauer, Andrea; Schmitt, Jochen; Bennett, Cathy; Coenraads, Pieter-Jan; Elsner, Peter; English, John; Williams, Hywel C. (16 June 2010). "Interventions for preventing occupational irritant hand dermatitis". Cochrane Database of Systematic Reviews (6): CD004414. doi:10.1002/14651858.CD004414.pub2. PMID 20556758.
- Robert L. Rietschel; Joseph F. Fowler; Alexander A. Fisher (2008). Fisher's Contact Dermatitis. PMPH-USA. pp. 333–. ISBN 978-1-55009-378-0.
- Richard J. G. Rycroft (1 January 2001). Textbook of Contact Dermatitis. Springer Science & Business Media. pp. 989–. ISBN 978-3-540-66842-8.
- Mark G. Lebwohl; Warren R. Heymann; John Berth-Jones; Ian Coulson (19 September 2013). Treatment of Skin Disease: Comprehensive Therapeutic Strategies. Elsevier Health Sciences UK. pp. 336–. ISBN 978-0-7020-5236-1.
- Corazza M, Minghetti S, Bianchi A, Virgili A, Borghi A (2014). "Barrier creams: facts and controversies". Dermatitis 25 (6): 327–33. doi:10.1097/DER.0000000000000078. PMID 25384222.
- Pace WE (1965). "A benzoyl peroxide-sulfur cream for acne vulgaris.". Can Med Assoc J 93: 252–4. PMC 1928665. PMID 14328040.
- Bansal, I., & Bansal, S. (2015). "Social Media Marketing – An Overview". Sai Om Journal of Commerce & Management: A Peer Reviewed International Journal 2: 1–6.
- "WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care". WHO Press. 2009. Retrieved 2 October 2015.
- John M. Boyce, Didier Pittet (October 25, 2002). "Guideline for Hand Hygiene in Health-Care Settings". Morbidity and Mortality Weekly Report.
- Susan Macqueen (18 June 2012). The Great Ormond Street Hospital Manual of Children's Nursing Practices. John Wiley & Sons. pp. 181–. ISBN 978-1-4051-0932-1.
- "Silon". FASS (drug formulary).
- Williams, Del (2005). "Shielding Lotions". Dimensions of Critical Care Nursing 24 (4): 181–182. doi:10.1097/00003465-200507000-00008. ISSN 0730-4625. PMID 16043981.
- Lewis, Tanya (31 July 2006). "Online effort establishes new category of skin care". PRWeek.
- "Case Study: SkinMD" (PDF). press-feed.com.