Skin Research and Technology 2001; 7: 214–218
Printed in Denmark. All rights reserved
Efficacy of corticosteroids in acute experimental irritant
contact dermatitis?
Cheryl Levin, Hongbo Zhai, Saqib Bashir, Ai-Lean Chew, Angela Anigbogu, Robert Stern and
Howard Maibach
University of California at San Francisco Medical Center, San Francisco, CA, USA
Background/aims: Topical corticoids are used to treat irritant
contact dermatitis (ICD) in humans. However, their clinical effi-
cacy remains sub judice. This study was designed to assess
the efficacy of low- and medium-potency corticosteroids on irri-
tant dermatitis.
Methods: We induced an acute ICD via open application of
sodium lauryl sulphate (SLS) on the hands of subjects. The
dorsal side of hands was irritated with 10% SLS five times in
one day. Once on day 1 and twice daily on days 2–5, 1%
hydrocortisone, 0.1% betamethasone-17-valerate and vehicle
cream (petrolatum) were applied subsequently. Visual grading,
bioengineering techniques and squamometry were used to
quantify skin response.
I RRITANT contact dermatitis (ICD) is a multifactorial
disease, resulting from acute or cumulative ex-
posure. Traditionally, topical corticoid therapy is
widely utilized, though experimentation in humans
provides conflicting results (1). In theory, while the
anti-inflammatory properties of corticoids could im-
prove the dermatitis, their anti-proliferative effects
might slow recovery of the skin barrier and allow
further penetration of irritants (2, 3).
Occlusive application of surfactant on human sub-
jects is a widely employed method of inducing irri-
tant contact dermatitis in vivo. However, the devel-
opment of clinical ICD typically occurs following
open exposure to detergents or other chemical irri-
tants. Open application of surfactant (rather than
patch) mimics a more realistic clinical scenario (4, 5).
We induced an acute ICD via open application of so-
dium lauryl sulphate on the hands of subjects to de-
fine the efficacy of low- and medium-potency corti-
costeroids on irritant dermatitis. Bioengineering tech-
niques and squamometry were used to quantify skin
response.
214
Copyright C Munksgaard 2001
Skin Research and Technology
ISSN 0909-752X
Results: Corticosteroids were found ineffective in treating the
surfactant-induced irritant dermatitis when compared with the
vehicle and with the untreated control.
Conclusion: The counterintuitive result (in a relatively realistic
and robust model) should be interpreted with caution until veri-
fied with other irritants of varying physicochemical properties.
Key words: irritant dermatitis – corticosteroid – transepidermal
water loss – squamometry – colorimetry
c Munksgaard, 2001
Accepted for publication 17 January 2001
Material and Methods
Subjects
Six healthy volunteers, aged 49∫8 (mean∫SD) years,
provided written informed consent for participation
in a double-blind study (5 men, 1 woman) approved
by the University of California Committee on Human
Research. None of the subjects had a history of atopic
dermatitis or presented with dermatitis at or near the
test sites. The studies were performed in April 2000.
Material and measurements
Ten percent sodium lauryl sulphate (SLS; 99% purity,
Sigma, St. Louis, MO, USA) dissolved in deionized
water induced ICD. Treatments included 0.1% beta-
methasone-17-valerate ointment (Alpharma, Balti-
more, MD, USA) and 1% hydrocortisone ointment
(Pfizer, New York, NY, USA). Petrolatum USP served
as a vehicle control.
Transepidermal water loss (TEWL) was measured
with an evaporimeter (TewameterTM 210, Courage &
Khazaka, Cologne, Germany). TEWL is a sensitive

measure of skin water barrier function (6, 7), and
probes detect changes in the water vapor gradient
between the skin surface and the ambient air. A
colorimeter (Chroma Meter CR 300, Minolta, Osaka,
Japan) evaluated the skin color. Colorimetry assesses
the blanching effect of corticosteroids by measuring
three space parameters of light (L*a*b*). The L* value
represents luminance, a* depicts the blend of red and
green and b* measures the blend of yellow and blue.
The a* parameter was used, as it most closely corre-
lates with erythema (4, 8). Erythema and dryness
were assessed separately by a trained investigator
using well-established visual score methods (9). A
graded scale of 0–4 was used to describe both the
erythema and dryness that occurred with the irritat-
ing agent, with 0 characterizing no redness or no
erythema and 4 describing a fiery redness or a very
intense dryness. This grading system is described in
detail in Tables 1 and 2. The outer layer of stratum
corneum was stripped with a tape disc (D-Squame,
Cuderm Corporation, Dallas, TX, USA).
Methods
Upon acclimatization to the room temperature (18–
22 æC, relative humidity 44–61%) for 30 min, two ran-
domized sites were chosen on the dorsal side of each
of the volunteer’s hands for a total of four sites. Base-
line measurements of transepidermal water loss, skin
color and visual score were taken at the selected loca-
tions. On one additional randomized site, a single
stratum corneum stripping was performed, based on
previously described methodology (10, 11). One tape
disk was applied for 5 s onto the skin using 10 kPa of
TABLE 1. Visual score of erythema
Grade Description
0 No erythema
1 Slight redness
2 Moderate redness
3 Intense redness
4 Fiery redness
TABLE 2. Visual score of dryness
Grade Description
0 No erythema
1 Slight dryness without scaling
2 Moderate dryness and scaling
3 Intense dryness and scaling
4 Very intense dryness and scaling
Efficacy of corticosteroids in ICD
pressure. The disk was then removed with forceps in
a uniform direction. This procedure is known as squa-
mometry.
An open application hand washing assay (9) in-
duced irritation on the dorsal side of the hands. The
investigator rubbed 1 ml of 10% SLS solution in her
hands using tepid tap water (water hardness: 58 mg/l
CaCO3). Both of the volunteer’s hands were washed
with the same lather 30 times (for approximately 1
min) and then rinsed for 15 s. The procedure was re-
peated hourly for a total of five hand washes in 1 day.
SLS was used to model ICD because it is known to
damage the skin barrier without causing excessive
discomfort to the volunteers (12, 13).
Immediately after the final washing, three sites
(each with an area of 2.83 cm2) were treated, respec-
tively, with approximately 18 mg/cm2 of betame-
thasone valerate, hydrocortisone and petrolatum. A
graded syringe was used to apply the ointments, so
that an equal amount of ointment would be adminis-
tered to each site. One site was untreated. Investi-
gators and subjects were blinded to the formulations
tested. The ointments were openly applied once on
the first day and then twice daily at approximately
10:00 a.m. and 4:30 p.m. for four consecutive days.
Bioengineering and visual score measurements were
taken daily before the second corticoid application.
One stratum corneum stripping was performed on
each site before the final corticoid application. Squam-
ometry was used to analyze the tape discs. The meth-
odology involves staining each tape disc for 30 s with
one drop of toluidine blue and basic fuschin solution
(Polychrome Multiple Stain Delasco, Council Bluff,
IA, USA) and then mounting it on a frosted micro-
scope slide (Fisher, Pittsburgh, PA, USA). The slide is
dried on a slide warmer for 10 min. The Chroma C*
value of the stained discs, which roughly correlates
with the amount of stratum corneum stripped (10),
was measured (Chroma Meter CR 300, Minolta,
Osaka, Japan). C* is defined as (a2πb2)0.5. A micro-
scope magnification of ¿100 was utilized to evaluate
intercorneocyte cohesion and the amount and distri-
bution of dye in cells. Intercorneocyte cohesion was
graded as follows: 0Ωlarge sheet; 1Ωlarge clusters and
few isolated cells; 2Ωsmall clusters and many isolated
cells; 3Ωclusters in disruption, most cells isolated; 4Ω
all cells isolated, many cases of lysis. The amount and
distribution of dye in cells was scored according to
the following scale: 0Ωno staining; 1Ωstaining be-
tween cells or slight staining in cells; 2Ωmoderate
staining in cells; 3Ωlarge amount of staining in cells,
but uniform; 4Ωimportant staining in all cells, often
with grains.
215
Levin et al.
Statistical analysis
The differences in mean TEWL and colorimetric
values between the treated, untreated, and vehicle
control test sites were tested for significance using a
repeated-measures ANOVA. The Friedman statistic
evaluated visual and microscopic scores. A value of
P⬍0.05 was considered significant.
Results
TEWL, chromametry and visual score
SLS induced a significant mean increase in TEWL at
all test sites (Fig. 1). There was no significant change
in TEWL measurements with any of the formulations
when compared with each other and with untreated
skin.
SLS induced a decrease in chromametric values in
all test sites. No statistically significant change in
chromametric values was observed with any of the
formulations tested when compared with each other
and with untreated skin. The visual score did not dis-
criminate between vehicle, untreated, or corticoid-
treated sites.
Squamometry
Chroma C* values for vehicle, untreated and corticoid
formulations did not significantly differ. Microscopic
analysis of intercorneocyte cohesion and amount and
distribution of dye in cells did not differentiate be-
tween treated or untreated test sites.
Fig. 1. TEWL mean difference from baseline (10% sodium lauryl sul-
phate). There was no significant change in TEWL measurements with
any of the formulations when compared with each other or with un-
treated skin. TEWL was significantly increased at all test sites
(P∞0.05).
216
Discussion
Corticoids may suppress some mildly irritant reac-
tions in humans if given before or concomitant with
the insult (14, 15). However, when given subsequent
to irritation, corticoid effect remains unclear. The pres-
ent study found corticosteroids ineffective in treating
SLS-induced acute irritant contact dermatitis of the
hands. Previous studies by Van der Valk (16) and Le
(17) concluded similar results: corticoids were associ-
ated with no or possibly a negative effect in treating
cumulative ICD. SLS was selected as the irritant in
this study because of its ability to lightly damage the
skin without sensitizing or causing excessive dis-
comfort to the human volunteers (12).
We focused on mimicking a clinically realisitic en-
vironment. In contrast to previous studies that used a
patch to induce ICD (16–19), we chose to irritate the
skin subclinically via a hand washing assay, since the
development of ICD may occur following open ex-
posure to detergents or other chemical irritants (20,
21). Under occlusion, the damaging effect of SLS and
other detergents may reflect irritation of deeper skin
layers. Therefore, open application and patch testing
may investigate different aspects of skin barrier func-
tion (22, 23). We applied corticosteroids twice daily
(except for day 1), since this is often the dermatol-
ogist’s recommended dose in the treatment of ICD.
However, studies comparing repetitive dosing to a
single dose have failed to reveal increased absorption
of corticoids with frequent dosing (24, 25). Since ICD
is often localized to the hands, we chose the hands as
a model for corticosteroid-treated irritant dermatitis.
Ramsing (18) and Berardesca (19) studied the effect
of corticosteroids on acute ICD and found corticoids
to be effective treatments. However, the effect was
small (10% and 7% reduction in TEWL, respectively).
Ramsing only observed an effect on the 7th day of
treatment on the contralateral arm; no significant ef-
fect was observed when comparing treated and un-
treated skin on the same arm or on the first six days
of treatment. While Berardesca found statistical sig-
nificance when comparing corticosteroid-treated and
untreated skin, his study did not compare corticoid
treatment to vehicle control.
Squamometry has previously discriminated be-
tween corticosteroid-treated, vehicular and untreated
skin in the treatment of atopic dermatitis (26) and has
assessed the degree of irritation induced by SLS (9).
In our study, squamometry was non-differentiating.
This is consistent with our results using bioengineer-
ing equipment, namely TEWL and chromametry.
Chromametry values decreased subsequent to SLS-

induced irritation and corticosteroid application. This
may have resulted from a 3 æC drop in temperature
from day 1 to day 2, causing increased vasodilation of
blood vessels (27). The known blanching effect associ-
ated with corticosteroids may have contributed to the
decreased a* value as well (28).
Our study’s findings are significant, but not without
limitation. We tested corticosteroid efficacy in treating
SLS-induced ICD; inducing ICD with other irritants
might be beneficial. Though acute skin challenge with
a surfactant reflects the transient susceptibility of skin
to the particular irritant, it does not investigate the
skin’s repair mechanisms to cumulative irritation.
Cumulative dosing of irritant, as performed by Van
der Valk (16) and Le (17) would better satisfy this cri-
terion. Increasing numbers of subjects might discrimi-
nate small differences; yet, the experimental design
(each person acting as their own control) has shown
significant discriminatory power in other studies (11).
Other experimental conditions, including the type of
chamber used (29), the concentration of surfactant
(30), and the temperature of application (31), should
not be neglected as they may also affect study results.
Taken together, we’re impressed with the paucity of
evidence to document the ubiquitous use of topical
corticoids in irritant dermatitis. Thus, we should be
motivated to document their relevance in the various
types of irritant dermatitis. We’re aware of the
strengths and weaknesses of experimental data; yet, if
we can show no clear effect in controlled conditions,
we’re less likely to do so in a clinical setting.
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