Our skin is the largest organ of the body, weighing about nine pounds and covering eighteen square feet in adults. It consists of three layers of tissue: the epidermis, dermis and a deeper layer of tissue called the hypodermis. The epidermis is the skin's outer layer, which contains no blood vessels and receives its nourishment from the dermis. The outermost layer of the epidermis is the stratum corneum. This is composed of flattened dead cells called corneocytes or squames attach to each other to form a tough layer. That serves as the primary protective barrier. The stratum corneum is key in helping your skin retain moisture and lipids in order to maintain pliability and barrier effectiveness. Because glove materials do not permit the evaporation of skin moisture, they can alter the stratum corneum, resulting in a reduction of protective barrier properties.i Additionally, water under occlusion can disrupt the skin's barrier lipids and also damage the stratum corneum, similar to the mechanism of surfactants.ii In addition to frequent and long-term glove usage, there are several other causes of irritation/contact dermatitis among clinicians. These include: Frequent occupational exposure to various soaps, detergents, disinfectants and other caustic chemicals known to cause changes to the skin Seasonal low humidity Glove powder, especially among exam glove wearers Donning and removal of gloves, especially if not Hand-care product usage Moisturizing with effective, clinically appropriate products can help prevent dehydration, damage to barrier properties, excessive desquamation (i.e., skin cell shedding) and loss of skin lipids, as well as restore the water-holding capacity of the keratin layer. Several controlled trials have demonstrated that regular use of hand lotions or creams helps prevent and treat irritant contact dermatitis.iii There is even biological evidence to support the idea that the use of emollients on the skin of health-care professionals may be protective against cross-infection.iv However, numerous articles note that failure to use supplemental hand lotions or creams is one of the factors contributing to dermatitis associated with frequent hand washing activity.v Wetting the skin relieves dryness only temporarily. For skin-care products to be truly effective, there must be restoration of the skin barrier. Once the skin has been damaged and the stratum corneum barrier function impaired, barrier repair can only occur if the loss of moisture is inhibited.vi This requires protectants for the skin in addition to skin restoration and healing. Common practice for clinicians is to use over-thecounter hand lotions and moisturizers in the clinical environment; from an infection prevention standpoint, this is unacceptable. These products may harbor and grow infectious microorganisms and are not approved for use in the health-care setting. Most of these products are highly fragranced, are not compatible with other hand-hygiene products and can be the source of either an acute or chronic irritation. The Centers for Disease Control and Prevention (CDC) guidelines provide even more evidence that addressing skin dermatitis is a critical health-care issue. In light of these new guidelines, clinicians should insist on products that: Promote and maintain healthy skin Reduce trans-epidermal water loss Increase skin hydration (moisturization) Have low irritancy potential The potential added cost of these products can be easily justified by the increased adherence to hand-washing protocols and the impact on clinician and patient health and well-being. Characteristics of acute vs. chronic dermal irritation   Onset Severity Duration Typical symptoms Acute dermal reactions Rapid Severe Short Redness, itching, possibly burning Chronic dermal reactions Longer term Range from mild/localized to severe Long Cracks, fissures, hard bumps, sores

References
i NIOSH and Project Nora.(1996).Latex Allergy News . 11(5),1084-1121.
ii Prevalence and Correlates of Skin Damage on the Hands of Nurses.(1997 September/October). Heart &Lung .(Vol.26, No.5), 404-412.
iii Boyce, J.M., Pittet, D.(2002).Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand
Hygiene Task Force.Infection Control and Hospital Epidemiology. (Vol.23, No.12).
iv Larson, E., et al.(1998).Changes in bacterial flora associated with skin damage on hands of health-care personnel.Am J Infection Control. (Vol.26),513-521.
v Ibid.
vi Boyce, J.M., Pittet, D.(2002).Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand
Hygiene Task Force.Infection Control and Hospital Epidemiology. (Vol.23,No.12).
vii Ibid.
viii Ibid.
ix Grove, G.L.,et al.(2001).Methods for Evaluating Changes in Skin Condition Due to the Effects of Antimicrobial Hand Cleansers: Two Studies Comparing a New Waterless Chlorhexidine Gluconate/Ethanol
Emollient Antiseptic Preparation with a Conventional Water-Applied Product.Am J Infection Control. (Vol.29,No.6),361-369.
x Menne,T. and Maibach, H.(2002).Hand Eczema (2nd ed.).CRC Press.Boca Raton,FL.
xi Ibid.