Introduction

The expression "barrier cream'' is used most often to indicate those creams that are used in the context of prevention of irritant contact dermatitis (ICD) [1]. The use of this type of product, however, is much broader than the medical care circuit (diagnosed patients by dermatologists, general practitioners, or other healthcare professionals), and in fact the major sales of barrier creams is in the segments of skincare and occupational use. In these segments there is quite some mix-up between ''barrier creams,'' ''emollients,'' and ''moisturizers,'' both in use and marketing. However, contemplating on insights gained during the last one and a half decades in both the causes and prevention of ICD [2-6], a more consummated view on treatment options can be given [7,8]. Repeated exposure of the skin to low concentrations of irritants, low temperatures, or friction during daily wear and tear of the skin, may lead to a gradual lowering of treshold for disruption of the skin barrier, and consequently to ICD. This means that it makes sense to distinguish prevention and treatment options for people who are at risk for developing ICD. In this respect persons with a history of (skin) atopy should be considered, along with those whose occupational environments create the aforementioned conditions. It will be evident that prevention of skin barrier problems has two aspects, namely risk avoidance, e.g., by minimizing contact time with irritating conditions and fluids, and protection of the skin, e.g., with gloves or protective products. If despite these measures the skin gets abrogated, it is important to apply products that have the capacity to aid or accelerate skin repair.

Consequently, these principles should be reflected in the definition and choice of topical products used in the management of skin-barrier problems in general and ICD in particular. It is therefore proposed to classify such products as ''barrier protective'' (BP) and ''barrier restorative'' (BR) products. In this view, BP products are considered products that guard the skin against the deleterious influences of exogenous stimuli leading to barrier disruption and consequently to the development of ICD. On the other hand, BR products are defined as being intended to restore a disrupted skin barrier. Both types of products can appear as ointments, creams, milks, and foams.

Because of the different functions of BP and BR products in the management of skin-barrier problems, it is noteworthy to consider that this has an impact on the properties that are expected from such products. In this respect it is important to realize that protective

Shielding

Figure 1 The primary function of a protective product.

products have the primary function to shield the skin (Fig. 1), but that this should be accomplished under conditions where people are working in a household or occupational environment. This implies that not only the shielding properties of such preparations, but also whether or not these products can be used under daily working conditions are important. Because occupational conditions may vary tremendously, it is not surprising that this has an impact on what can be called the ''secondary properties'' of BP products, which mean that BP products for e.g., hairdressers, kitchen workers, and slaughterhouse workers should offer the same level of protection but with different wash and wear resistancy as well as cosmetic properties. This requires special products for specific user groups.

In contrast, for BR products there is, in principle, no need for differentiation on the user's occupation, because these products are intended to be used after work. However, because different irritants cause differential structural alterations in e.g., the horny layer of the skin [9], this may require different types of BR formulations. Figure 2 depicts the differences between protective and restorative products. Consequently, product properties can be defined and criteria can be set to comply with.

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