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The Vulva Skin Microclimate: Influence of Panty Liners on Temperature, Humidity and pH
Abstract
Many women use panty liners between menstrual periods. The aim of this study was to investigate whether the use of such products might influence the vulva skin. Twelve healthy women were studied on four occasions with three different product constructions and on one occasion without products. Temperature, surface wetness and surface pH were measured on vulva skin. Mean skin temperature when the women were wearing a conventional panty liner (with a non-breathable back sheet) was 35.9 degrees C, compared to 34.4 degrees C when wearing no panty liner at all (p < 0.01) and 34.5 degrees C when using a panty liner with a breathable (i.e. vapour permeable) back sheet (p < 0.01). Skin humidity was significantly higher when the conventional panty liner was used compared to no panty liner or to the breathable panty liner (both cases p < 0.01). The mean pH value at the exterior aspect of the labium majus was 5.8 with the conventional panty liner, 5.2 with no panty liner and 5.3 with the breathable panty liner (p < 0.001 and p < 0.01, respectively). The results indicate that the conventional panty liner changes the vulva skin microclimate, but that the breathable panty liner to a substantial degree keeps the microclimate at an undisturbed level. The actual effect of these differences on microbiological flora will be addressed in a subsequent study.
... However excessive occlusion and humidity in the area of vulva caused by synthetic underwear, tight pants, menstruation and the use of sanitary pads may have a negative influence on the skin barrier and cause changes in temperature and pH of the region, making the vulva susceptible to vulvovaginal diseases (2)(3)(4) . The most common types of vulvovaginitis in the reproductive age of women are bacterial vaginitis (BV) and vulvovaginal candidiasis (VC), and they usually manifest as vaginal discharge accompanied by bad odour and itching, respectively (5) . ...
... maintain the natural humidity of the area in contact with the skin, and change vulvar or vaginal pH, causing physiological changes that could favor fungus and bacteria growth; therefore, vaginal infections such as vulvovaginal candidiasis (VC) could install much more easier (3) . Runeman et al. (5) performed a study with 58 women used to wear non breathable sanitary pads, with a plastic layer, for three menstrual cycles in between flow days (panty liners). Vulvar temperature, pH and humidity increased significantly compared to women not using them or using breathable types. ...
... The literature holds some questionings about the potential risks of long-term use of sanitary pads to women's health, once there is increase in the temperature of the area, change in vulvar or vaginal pH, and maintenance of humidity, which can favor bacterial and fungus growth, and, therefore, vulvovaginal infections (3,5,(8)(9)(10)19) . But we found no differences as to this aspect. ...
Introduction: Vulvar occlusion and moisture buildup resulting from the use of sanitary pads, synthetic underwear and/or tight pants are considered risk factors for the development of vulvovaginitis (VV). However, this association is still poorly elucidated. Objective: To associate the use of sanitary pads and clothing with the presence of bacterial vaginitis (BV) and vaginal candidiasis (VC). Methods: Cross-sectional study aimed at analyzing the use of sanitary pads and clothing in 307 volunteers from 18 to 45 years old, with and without BV and/or VC. A questionnaire comprehending six domains was applied individually to the volunteers, in an outpatient gynecology clinic at a university hospital (University of Campinas, Brazil). This study analyzed three of six domains. Vaginal material was collected for microbiologic diagnosis of BV (Nugent criteria) and VC (Gram stain and culture of the fungus in Saboureaud). Exclusion criteria were: use of antibiotics within 15 days, history of cancer, positive HIV and/or syphilis and immunosuppressive disease. Statistical analysis were made with Fischer and chi-square tests, using the software EPI INFO 0.5. Significance level was set at p
... A series of studies demonstrated the impact of panty liners on these variables [4][5][6]. An increase of approximately 1 8C in the mean temperature of the labium majus was measured in women who wore panty liners with impervious, non-breathable backsheets compared to women who wore no panty liners. ...
... A 34% increase in the rate of evaporation of skin surface moisture was measured immediately after underwear/liner removal in users of panty liners with impervious backsheets compared to non-users, although hydration of the underlying epidermis was unchanged [4]. However, panty liners with impervious backsheets caused no visual skin reactions [12]; moreover, although the cell density of total aerobic microbes on the labium majus was statistically higher in users of panty liners with impervious backsheets compared to non-users, the difference was about 0.3 log units, a clinically insignificant change. ...
... When applied to the forearm, feminine hygiene articles with vapor-permeable backsheets lowered skin surface water loss, skin hydration, and the relative humidity of the microenvironment between the pad and the skin under moderate conditions of environmental temperature and relative humidity (25 8C/50% relative humidity) [6]. Wearing panty liners with vapor-permeable backsheets and superabsorbent cores maintained vulvar skin temperature, skin wetness, and skin pH at levels more comparable to those observed with no panty liners; differences in vulvar microflora between the groups were negligible [4,12]. These studies suggest that breathable panty liners may improve the wearer's comfort by facilitating the transfer of heat and surface moisture from the skin. ...
Panty liners are used to absorb light menstrual flow, vaginal discharge, or urine leakage, or to maintain a clean, dry feeling. Allegations that panty liners may trap heat and moisture to promote vulvovaginal candidiasis (VVC) or promote colonization by microbes that contribute to urinary tract infections appear to be unfounded. As reviewed herein, measurements of the impact of panty liners on skin temperature and skin surface moisture had no clinically meaningful effect on cell densities of genital microflora. Epidemiological investigations of a potential link to VVC were either negative or were inconclusive because of confounding factors. Although enteric microbes reside on the vulva and perineum, no evidence exists that panty liner use promotes urethral colonization by enteric microbes. Moreover, a series of 13 randomized prospective trials of panty liners or ultra-thin pads demonstrated no clinically significant adverse effects either on the skin or on isolation frequencies or cell densities of representative genital microflora. Post-market surveillance systems suggest a low incidence of complaints. Evidence from vulvar clinic patients reveals no significant contribution of these products to persistent vulvar symptoms. Taken together, the scientific evidence supports the conclusion that panty liners are safe when used as intended and do not promote VVC or urinary tract infections.
... Due to occlusion, the fluid impervious back layer of sanitary products with may increase the skin temperature and surface skin moisture of the vulva. Studies by Swedish investigators demonstrated that panty liners have a small but measurable impact on the temperature and surface moisture of vulvar skin [52,53]. (The test period did not include the summer months). ...
... (The test period did not include the summer months). The mean temperature of labium majus in women who wore conventional panty liners was 1.5°C higher than in women who wore no panty liners [52]. This difference, though measurable, is comparable in magnitude to intra-day temperature fluctuations observed at other anatomical sites due to changes in ambient temperature, food intake, exercise, or circadian rhythms [10, 33,34,41,61]. ...
... The rate of moisture evaporation from the skin surface was 34% higher in women who wore conventional panty liners than in those who wore no liners. However, the hydration of the underlying vulvar epidermis, as measured by skin capacitance, was unchanged [52] and wearing panty liners caused no visually discernible skin reactions [53]. ...
Modern disposable sanitary pads are becoming available worldwide. Regional differences in usage practices, ethnicity, and climate may influence their skin compatibility. Pad usage practices depend on culture, economics, and menstrual physiology. Daily usage is higher in Japan and but lower in Nigeria compared to North America or Western Europe. Evidence for ethnic differences in skin irritant susceptibility is not compelling. Dark skin may be less susceptible to certain irritants than fair skin; the Japanese may experience a higher degree of sensory irritation than Caucasians. Ambient conditions such as high temperature and humidity increase the skin temperature and skin surface moisture under sanitary pads by small but measurable amounts, causing no discernible skin irritation; vapor-permeable pad backings reduce these effects. Cold dry conditions, which can irritate exposed skin, may not affect vulvar skin to the same degree due to its elevated hydration and occlusion. To address the practical significance of these variables, results of prospective clinical trials of sanitary pads performed by industry and academic scientists in North America (Indiana), Mexico, Western Europe (Munich, Athens, Goteborg, Sweden), Eastern Europe (Kiev) and Africa (Abuja, Nigeria) were reviewed. Despite the diverse range of conditions, no significant adverse skin effects were observed with modern pads compared to traditional pad designs. Study participants generally preferred modern pads for performance and comfort.
... These physiological changes can make it easier for vaginal infections like vulvovaginal candidiasis (VC) to develop (1). (2) conducted a research with 58 women who had worn plastic-covered, non-breathable sanitary napkins for three menstrual cycles between flow days (panty liners). Similar to sanitary pads, clothes may modify the vaginal microbiome owing to humidity and temperature fluctuations, altering the genital ecology and resulting in irritations, allergies, or discharge (1). ...
... The skin barrier may be negatively impacted by excessive occlusion and humidity in the vulva area brought on by synthetic underwear, tight pants, menstruation, and the use of sanitary pads, which can also change the temperature and pH of the area, making the vulva vulnerable to vulvovaginal diseases (4) (1). Bacterial vaginitis (BV) and vulvovaginal candidiasis (VC), the most prevalent kinds of vulvovaginitis in women of reproductive age, respectively, often present as vaginal discharge accompanied by a poor odor and itching (2). Table 2 shows that the highest percentage of 52 (37.1%) of the patient's responses were hygienic practice before/after intercourse by wiping with soft tissue. ...
Background: Vaginitis risk factors include vulvar occlusion and moisture accumulation brought on by the use of sanitary napkins, synthetic underwear, and/or tight jeans. Patients and Methods: A case-control study conducted on 100 patients women with vaginitis and 100 in the control group attending Kadhimiya Teaching Hospital and Medical City. The study used a convenience sampling technique (non-random sampling technique) to choose the patients with vaginitis and control groups via take swab vaginal and direct interviews. The data were collected during a period from the 1st of December 2021 to the end of May 2022. Results: The result explained that ages ≥ 50 years, and single, and menopausal women are more frequency in the control group compared to the study group. While reveals that the participants women who use not wipe with soft tissue, and soap and water are less likely for vaginitis than those who use it (OR; 0.278, and 0.488) respectively. In contrast, the participant's women who use not clean with water are more likely for vaginitis than those who use it ( B= 1.509; P. value<0.001; OR= 4.524; 95% C.I = 2.225-9.198).
... These physiological changes can make it easier for vaginal infections like vulvovaginal candidiasis (VC) to develop (1). (2) conducted a research with 58 women who had worn plastic-covered, non-breathable sanitary napkins for three menstrual cycles between flow days (panty liners). Similar to sanitary pads, clothes may modify the vaginal microbiome owing to humidity and temperature fluctuations, altering the genital ecology and resulting in irritations, allergies, or discharge (1). ...
... The skin barrier may be negatively impacted by excessive occlusion and humidity in the vulva area brought on by synthetic underwear, tight pants, menstruation, and the use of sanitary pads, which can also change the temperature and pH of the area, making the vulva vulnerable to vulvovaginal diseases (4) (1). Bacterial vaginitis (BV) and vulvovaginal candidiasis (VC), the most prevalent kinds of vulvovaginitis in women of reproductive age, respectively, often present as vaginal discharge accompanied by a poor odor and itching (2). Table 2 shows that the highest percentage of 52 (37.1%) of the patient's responses were hygienic practice before/after intercourse by wiping with soft tissue. ...
Background: Vaginitis risk factors include vulvar occlusion and moisture accumulation brought on by the use of sanitary napkins, synthetic underwear, and/or tight jeans. Patients and Methods: A case-control study conducted on 100 patients women with vaginitis and 100 in the control group attending Kadhimiya Teaching Hospital and Medical City. The study used a convenience sampling technique (non-random sampling technique) to choose the patients with vaginitis and control groups via take swab vaginal and direct interviews. The data were collected during a period from the 1st of December 2021 to the end of May 2022. Results: The result explained that ages ≥ 50 years, and single, and menopausal women are more frequency in the control group compared to the study group. While reveals that the participants women who use not wipe with soft tissue, and soap and water are less likely for vaginitis than those who use it (OR; 0.278, and 0.488) respectively. In contrast, the participant's women who use not clean with water are more likely for vaginitis than those who use it ( B= 1.509; P. value<0.001; OR= 4.524; 95% C.I = 2.225-9.198).
... air-and vapor-permeable) materials for pads used at times of low vaginal discharge (referred to as breathable panty liners [BPLs]) [10]. An average increase of 1 °C in the temperature of the outer labia was reported among women using panty liners with a plastic barrier, whereas no such increase was observed among BPL users [11,12]. ...
... Some studies have indicated that the use of tampons or pads interferes with local vulvar and/or vaginal homeostasis mechanisms [12,17,18], although others have shown that replacing the plastic barrier with a breathable material does not alter vaginal temperature/ moisture conditions [5,19,20]. ...
To evaluate whether the use of "breathable" panty liners (BPLs) alters the normal vaginal flora, increases the incidence of bacterial vaginosis and/or vaginal candidiasis, or causes vulvar irritation.
A randomized controlled trial assessed the vaginal ecosystem of women without complaints of vaginal discharge. The study group (n=53) wore BPLs for 10-12 hours each day for 75 consecutive days, whereas the control group (n=54) wore only their usual underwear. At each of 6 visits during 3 menstrual cycles, participants underwent gynecologic examination with colposcopic evaluation and pH measurement, in addition to assessment of vaginal microbial flora, intensity of inflammatory processes, and presence of vaginal candidiasis/bacterial vaginosis in Gram-stained smears.
After 75 consecutive days of BPL use, 40/44 (90.9%) and 42/44 (95.5%) women reported no complaints of vaginal discharge or vulvar itching/burning, respectively. There was no significant difference between the study group and the control group with regard to positive vaginal fungus cultures (5/44 [11.4%] vs 8/50 [16.0%]; P=0.7848) or bacterial vaginosis (3/44 [6.8%] vs 2/50 [4.0%]; P=0.7974) at the end of the study period.
After 75 days of BPL use, there was no significant increase in vulvovaginal candidiasis, bacterial vaginosis, vulvovaginal irritation, or vulvovaginal inflammation.
... In 2003 this figure increased to 60% and to 70% in 2004. 3 This increase in percentage was due to the tropical climate in Indonesia. This condition causes the feminine area to become moist so that the fungus can easily develop and cause vaginal discharge. ...
p>Vaginal discharge or fluor albus is a problem that is often found in women. Daily use of panty liner is a predisposing factor of pathological/abnormal vaginal discharge. This paper reviews the correlation between the use of panty liner and vaginal discharge. The aims of this study were to analyze the effect of daily panty liner use as a risk factor of vaginal discharge. This research is done by using the cross-sectional method. The study population is students of the University of Pelita Harapan in the Faculty of Nursery. Sample size calculation was done using the categorical comparative analytical formula and a result of 46 samples were obtained for each population. A questionnaire was used in this research. Statistical analysis is done by using the SPSS 22.0 program with the Chi-Square method. Bivariate analysis on 92 respondents revealed that there is a significant association between the usage of a panty liner and abnormal vaginal discharge (p-value <0.05). Based on bivariate analysis panty liner material is not related to abnormal vaginal discharge (p-value >0.05).</p
... However, they can change the microclimate and promote bacterial and fungal growth. Conventional liners with plastic back sheets increase the skin temperature, moisture and skin pH significantly, and 'breathable' (= vapour-permeable) or acidified products are preferable [40][41][42]. Sharp edges on liners may cause microabrasions and increase the risk of infection. Perfume and the disinfectant Cu (II)-acetyl acetonate were linked to contact urticaria and dermatitis [43]. ...
One-half of all travellers are women; yet, there is a distinct lack of detailed travel health knowledge on topics of unique relevance to women. While there is medical advice relating to stages in the female lifecycle, it neglects women-specific practical aspects despite their ability to harm travellers’ health and cause inconvenience. This paper discusses comprehensively three major aspects of travel as they relate to women. First, it suggests the management of personal hygiene, bodily functions, menstruation and sexual behaviour, and alerts to the limited knowledge on travel mental health issues.
Second, apart from travelling in a female body with its specific demands, being a woman requires special attention to safety and security. Within various travel contexts, women have many opportunities for minimising potential risks.
Finally, guided by travel medicine’s acknowledgment of its role in the concept of responsible travel, this article goes beyond the usual general statements and broad advice and offers detailed and practical suggestions on how the female traveller can contribute to the overall goal of minimising any potential harm to fellow humans and the natural environment. Recognising the scarcity of women-specific travel information, pathways to better education, and a range of suggestions for urgent research facilitate the provision of high-quality travel health care tailored specifically to women’s needs.
... 59 The use of conventional panty liners (i.e. with a nonbreathable back sheet) is a widespread practice but can increase the temperature, skin surface moisture, and pH of the vulvar skin, thereby significantly changing the microclimate of the vulva. 60 Extensive pubic hair removal, which was typically only done for cultural and religious reasons, has become more common for aesthetic reasons. 26,61,62 Hair removal may cause skin microtrauma and subsequent spread of infectious agents throughout the pubic area. ...
Women use various feminine hygiene products, often as part of their daily cleansing routine; however, there is a paucity of published medical literature related to the external vulva and how personal hygiene practices can affect it. This review article provides background information on the physiological changes that occur during women’s lives and reviews the relevance of transient and resident microbiota as they relate to common vaginal and vulvar disorders. It also discusses the need for female intimate hygiene, common practices of feminine hygiene from a global perspective, and the potential benefits of using suitable external, topical feminine vulvar washes to minimize the risk of vulvovaginal disorders and to improve overall intimate health in women around the world. Supported by international guidelines, daily gentle cleansing of the vulva is an important aspect of feminine hygiene and overall intimate health. Women should be encouraged to choose a carefully formulated and clinically tested external wash that provides targeted antimicrobial and other health benefits without negatively impacting on the natural vulvovaginal microbiota.
... However, the vulvar areas were significantly more acidic with pH values ranging from 5.59 to 6.04 after using potassium alum contained sanitary pad compared to the ordinary product. There are some evidences that, using nonbreathable hygienic products like panty liners results in higher pH levels than with the use of breathable ones [24]. Therefore our finding concerning skin pH indicates that the potassium alum contained product, is less occlusive than the control product. ...
Background: The cutaneous effects and suitability of a sanitary pad have been studied globally. Potassium alum has been used in menstrual pads as an antiseptic, astringent, deodorizer and antiperspirants. The aim of this study is to assess safety and suitability of a sanitary pad containing potassium alum (test) in comparison of simple pads (control) on healthy women residing in Iran. Methods: This was a phase III cross-over study design, conducted on 16 healthy women over the course of two menstrual periods. The levels of erythema, fissuring, edema and papule formation as well as burning, and itching sensations have been evaluated based on clinical observations and interviews. Measurement of pH and swabs for bacteria counting of vulvar skin were also performed. The subjects used one type of sanitary pad during their first menstrual period and then used the other type during their subsequent menstrual period. Then the evaluations were repeated and the subjects were asked to complete self-assessment questionnaires about product suitability. Results: All the volunteers (age: 18-50, mean: 37.43) completed the study. No signs of irritation were found in the clinical observations or in the interviews for either product. No significant difference from baseline was found in the number of total bacteria for either product but the vulvar areas were significantly more acidic after using product with potassium alum. The majority of subjects preferred the sanitary pad with potassium alum (p-value = 0.0416). Conclusion: Both types of sanitary pads used in this trial were same, however, the pad with Potassium alum was preferred by the participants for greater suitability.
... The use of panty liners has become a common habit among women seeking protection against menstrual blood stains on their clothing, non-menstrual vaginal discharge, and the release of genital odors at social events. Some studies have indicated that the use of tampons or pads interferes with local vulvar and/or vaginal homeostasis mechanisms, and they may provoke a contact dermatitis [6]. ...
Background: Vulvar contact dermatitis is inflammatory disorders of genital skin causing itch, burning, and plaques with overlying excoriation and linear fissures. Objective: To assess the effectiveness of a soft foam based on Tiab® system (TF), complex of titanium micro crystals covalently bound with silver ions associated with hyaluronic acid, as a treatment of vulvar contact dermatitis. Method: 36 patients with the diagnosis of vulvar contact dermatitis received an 10-days treatment, during which the subjects applied TF, complex of titanium micro crystals covalently bound with silver ions associated with hyaluronic acid on the affected vulvar surfaces, used once a day. Clinical symptoms (itching and burning) and signs (vulvar surface disruption) were documented at baseline and after 1 months of follow-up. Results: There was a significant reduction of symptoms between the basal scores and the symptoms complaints 1 months of follow-up. Moreover a significant reduction of excoriations and linear fissures was observed. Conclusion: The present study shows that application of TF can be an effective agents for the reduction of symptom and sign of vulvar contact dermatitis, and the medical device can be used as a preventive agent in predisposing condition of vulvar discomfort.
... Although infectious causes are responsible for most cases of abnormal discharge, it may also be secondary to chemical irritation or allergy [8]. Several researchers [9,10] who have studied the use of panty liners argue that prolonged occlusion of the genital area can change the temperature, pH, and microflora of the vaginal epithelium and vulvar skin, possibly leading to a higher occurrence of vulvovaginitis and other infections. However, the vaginal ecosystem does not depend only on external physicochemical conditions; its balance is the result of a complex interaction between the vaginal flora, microbial metabolites, and the immune response of the vaginal epithelium. ...
Background
Whether panty liners predispose to vulvovaginitis is unclear.
Objectives
To clarify the effects of the use of panty liners on the female genital tract.
Search strategy
Several electronic databases (including PubMed and Embase) were searched to identify studies published in English before May 3, 2012.
Selection criteria
Case–control studies, randomized controlled trials, and cohort studies comparing young women who did and did not use panty liners in the intermenstrual period were included.
Data collection and analysis
The quality of the studies was assessed using the Newcastle–Ottawa Scale or the Jadad Scale. Data from suitable studies were extracted for analysis.
Main results
Five articles met the inclusion criteria. Four studies—all of which included only healthy women—found no significant clinical implications arising from the use of panty liners. The fifth study was of women with recurrent candidiasis and showed that use of panty liners was associated with new candidiasis episodes.
Conclusions
The intermenstrual use of panty liners does not seem to have a negative effect on the vulvovaginal area.
AbstrakPenyebab tersering fluor albus (keputihan) patologis adalah infeksi. Proses infeksi dapat dipicu oleh banyak hal, salah satunya adalah karena pemakaian panty liner. Tujuan penelitian ini adalah menentukan hubungan antara pemakaian panty liner dengan kejadian fluor albus pada siswi SMA. Penelitian dilakukan pada siswi di enam SMA di kota Padang. Penelitian ini menggunakan desain cross sectional study dengan responden sebanyak 289 orang. Pengumpulan data responden dilakukan dengan wawancara terpimpin (pengisian kuisioner). Analisis statistik yang digunakan adalah uji chi-square. Hasil penelitian didapatkan bahwa lebih dari separuh responden yang memakai panty liner mengalami fluor albus (69,2%) dan 80% diantaranya mengganti panty liner <2 kali perhari. Uji statistik chi- square menunjukkan ada hubungan yang bermakna antara pemakaian panty liner dengan kejadian fluor albus (p<0,05) dan frekuensi penggantian panty liner perhari dengan kejadian fluor albus (p<0,05). Terdapat hubungan bermakna antara pemakaian panty liner dengan fluor albus pada siswi SMA di Kota Padang.Kata kunci: fluor albus, panty liner, siswi SMA AbstractThe most common of pathology fluor albus is infection. Infection can be cocked by panty liner uses. The objective of this study was to determine relationship between panty liner uses and the incidence of fluor albus in female student of Senior High School. The research was executed to female student of senior high school in Padang. There are six schoosl was chosen as sample. This research used cross sectional study design to 289 respondent. Data was collected by guided interview. Statistic analysis use chi-square test. The result of research found more than half respondent who use panty liner experience of fluor albus (69.2%) and 80% of them just replace panty liner<2 times a day. Chi-square test showed that there is significant relationship between panty liner uses with fluor albus experience (p<0.05) and frequency of panty liner uses replacement with fluor albus experience (p<0.05). There is a significant relationship between panty liner uses and the incidence of fluor albus in female student of senior high school at Padang.Keywords: fluor albus, panty liner, female student of senior high school
This integrative review considers the role of skin occlusion and microclimate in incontinence-associated dermatitis (IAD), with a particular focus on disposable, body-worn, absorbent incontinence products. Although the mechanisms are not fully understood, the primary causes of IAD are well-established: occluded skin, in prolonged contact with urine and/or feces and exposed to abrasive forces, is more likely to be affected, and each of these factors can be influenced by wearing absorbent incontinence products. Studies comparing the effect of various absorbent products on skin health have been hindered by the many differences between compared products, making it difficult to clearly attribute any differences in performance to particular materials or design features. Nevertheless, the large and significant differences that have sometimes been found invite further work. Breathable back sheets can significantly reduce the temperature of occluded skin and the humidity of the adjacent air, and several treatments for nonwoven top sheet materials (used next to the skin) have been shown to impart antimicrobial properties in the laboratory, but an impact on IAD incidence or severity has yet to be demonstrated directly. Recent work to introduce sensing technology into absorbent incontinence products to reduce the exposure of skin to urine and feces, by encouraging prompt product changing, seems likely to yield measurable benefits in terms of reducing incidents of IAD as the technology develops. Published work to date suggests that there is considerable potential for products to be engineered to play a significant role in the reduction of IAD among users.
This study examined the enhanced properties of Laurier F®, a new sanitary napkin that reduces overhydration and physical stimulus, using 16 female subjects with sanitary napkin dermatitis.
Initially, subjects used their regular sanitary napkins during their menstrual period. Subsequently, during their next menstrual period, they used Laurier F napkins. After using their regular napkins, the Laurier F napkins, and a non-menstruation period, dermatologists examined the condition of the skin in the area under the napkin and interviewed the subjects about their symptoms. In addition, the subjects completed a diary about using the napkins and answered questionnaires about their usage.
Of the 16 subjects, 15 had erythema, 8 had maceration and 7 had scaling, accompanied by itching and/or stinging after using their regular napkins. However, usage of Laurier F napkins caused erythema only in 5 of the subjects, 1 had maceration and 1 had scaling. Accompanying these reductions, the symptoms were relieved. These results suggest a marked reduction in the severity of dermatitis in subjects after use of Laurier F napkins. In addition, the questionnaires revealed improvement in the subjective sensation during and after the use of Laurier F napkins compared to other brand of napkins.
Products for baby and adult incontinence and feminine hygiene are important parts of daily life for millions of people around the world. The consumer needs, clinical performance and skin care requirements and technologies used in these products are similar across product categories; therefore, this chapter will cover a range of absorbent products used for personal health care and hygiene. It will explore the needs of patients and consumers, hygiene implications, testing methods, and the application of innovative technologies to products. Finally, we will discuss emerging trends in this field, and provide sources that may be of use to the reader interested in obtaining additional information.
Severe illness, disability and immobility increase the risk of pressure ulcer development. Pressure ulcers are localized injuries to the skin and/or underlying tissue as a result of long enduring pressure and shear. Little is known about the role of the stratum corneum and the upper skin layers in superficial pressure ulcer development.
To investigate possible effects of long enduring loading on the skin barrier function under clinical conditions at two pressure ulcer predilection sites.
Under controlled conditions 20 healthy females (mean age 69.9 (3.4) years) followed a standardized immobilization protocol of 90 and 150 min in supine position wearing hospital nightshirts on a standard hospital mattress. Before and immediately after the loading periods skin surface temperature, stratum corneum hydration, transepidermal water loss and erythema were measured at the sacral and heel skin.
Prolonged loading caused increases of skin surface temperature and erythema at the sacral and heel skin. Stratum corneum hydration remained stable. Transepidermal water loss increased substantially after loading at the heel but not at the sacral skin.
Skin functions change during prolonged loading at the sacral and heel skin in aged individuals. Accumulation of heat and hyperaemia seem to be primarily responsible for increasing skin temperature and erythema which are associated with pressure ulcer development. Increased transepidermal water loss at the heels indicate subclinical damages of the stratum corneum at the heel but not at the sacral skin during loading indicating distinct pathways of pressure ulcer development at both skin areas.
Copyright © 2015 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.
Many women experience an itchy and unpleasant feeling in the genital skin during a menstrual period. It is thought that these skin problems are induced by the stimulation of menstrual blood flow and localized high temperature and damp environment caused by the use of napkins. However, it is not clear whether skin problems associated with use of napkins is related to atopic dermatitis (AD). We performed a questionnaire survey because we thought that treatment of AD should be decided while taking genital skin problems into consideration. At the time of menstruation, about 3/4 of the subjects complained of itching and half of the subjects showed skin symptoms. AD patients with more severe eruptions were more susceptible to the genital skin problems. When those same subjects used the sanitary napkin Laurier® F, which is designed for sensitive skin, they felt that their genital skin condition improved.
The vulva-vaginal infections are common in women. The textile materials, used in underwear and absorbent hygiene products, are identified as risk factors, but their influence on the emergence of these infections is not yet clear. Bacterial adhesion is associated with persistence of microorganisms in the material that is related to the recurrence of infections. This paper is an initial attempt for the elucidation of these questions. Some of the main features involved in this phenomenon are identified and characterized.
The cutaneous and sensory effects of the practical usage of sanitary pads have been studied globally. However, clinical studies in the United States were conducted only quite a long time ago, and the results of these studies were not published.
Fifty-four women residing in the United States were asked to use commercially available sanitary pads with a nonwoven unique surface sheet and pads with a perforated film. This was a cross-over study design conducted over the course of two menstrual periods. A board certified dermatologist evaluated the levels of erythema and fissuring, burning, stinging and itching sensations based on clinical observations and interviews. Measurement of pH and swabs for bacteria counting of vulvar skin were also performed. Data from the first clinical evaluation conducted prior to the first menstrual cycle were used as the baseline. At the end of the study, the subjects were asked to complete self-assessment questionnaires about product suitability.
Forty-two women (age: 18-50, mean: 37.5) completed the study. No signs of irritation or meaningful differences from the baseline were found in the clinical observations or in the interviews by the dermatologist for either product. No significant difference from baseline was found in the vulvar skin surface pH or in the number of total bacteria for either product. The results of the suitability indicated that the majority of subjects were highly satisfied with both types, but they especially preferred the sanitary pad with a nonwoven unique surface top sheet.
These results revalidate the results of a previous clinical study in the United States and are consistent with recent reports of worldwide clinical trials of high performance sanitary pads.
Regional differences in practices, ethnicity, and climate may influence the skin compatibility of sanitary pads. Although several clinical trials have been performed in North America, Mexico, Western Europe, Eastern Europe, and Africa, there is no clinical study reported for Asia.
The purpose of this study was to examine the skin compatibility of two types of modern sanitary pads in Chinese women along with a dermatological assessment and their satisfaction and preference.
The self-feeling and safety of a new sanitary pad with a non-woven top specially-shaped surface sheet was tested and compared with a conventional sanitary pad with a perforated film top sheet. The subjects studied were 22 Chinese women (age: 20-50 years) with a history of mild and occasional sanitary pad dermatitis residing in Shanghai. One subject wished to discontinue the trial for personal reasons, thus 21 subjects completed the trial. These subjects were randomly assigned to two types of sanitary pads, and used one type during their next menstrual period, and another type during their following menstrual period. After each menstrual period, a dermatologist examined the objective and subjective skin symptoms and determined a score. The subjects were asked to rate their level of satisfaction with respect to overall usability, softness, stickiness, dryness, and absorbency, and to choose which pad they had preferred.
No adverse effect was observed for either type of pad. Edema, erythema, burning, and stinging were not obvious symptoms for either type of pad. For itching, 30-65% of the subjects scored slight or mild for both types of pads. A comprehensive evaluation showed that several symptoms were observed on both type of pads at slight and mild levels, but minimal and insignificant differences were found between them. The majority of subjects were highly satisfied with both types, but preferred the new sanitary pad with a non-woven specially-shaped surface top sheet for its softness and absorbency.
Our results indicate that both types of sanitary pads were tolerated well by Chinese women, thereby providing an important extension of earlier studies.
The aim of this study was to confirm findings that vapour-impermeable panty liners might impair skin climate, and to assess their impact on the skin microflora. Temperature, surface pH and aerobic microflora were measured on vulvar skin of 102 women. The mean skin temperature was 1.1 degrees C higher when using a vapour-impermeable panty liner compared with not using one. Use of panty liners with vapour-permeable back sheets and acidic cores resulted in skin temperature, pH and microflora levels that were very close to those observed in persons not using liners. The temperature, pH and total number of microorganisms were significantly lower for users of vapour-permeable panty liners than for users of vapour-impermeable ones (p <0.05, p<0.001 and p<0.001, respectively). The microorganism densities were usually higher when using the vapour-impermeable panty liner, but mean differences were minor. The use of panty liners seems not to imply a microbial risk for normal, healthy women.
The aim of the present study was to investigate if tight-fitting underwear (string panties) equipped with string panty liners affected the vulvar skin microenvironment differently to regular panties with standard panty liners. Thirty-two healthy women participated in a crossover study where temperature, humidity, surface pH and aerobic microflora were measured on vulvar skin. Vulvar skin temperature was 35.2 +/- 0.19 (mean +/- SEM) and 35.3 +/- 0.17 degrees C, respectively, for the two underwear systems. Mean humidity and mean skin surface pH at vulvar skin did not differ between the two systems. Barely noticeable differences were found for the aerobic microflora both at labium majus and at perineum. The mean total number of microorganisms in the two different panty liners was the same, 6.0 +/- 0.15 and 6.0 +/- 0.16, respectively (log CFU per panty liner). The differences in panty and panty liner design studied seem to have negligible impact on the vulvar skin microclimate, skin surface pH and aerobic microflora. No support was found for the assumption that a string panty system would result in higher contamination of vulvar skin by anorectal microflora.
It is not known why some individuals infected with herpes simplex virus type 2 (HSV-2), experience frequent recurrences, while most of those infected have a completely silent infection.
We wanted to study if local factors in the skin could explain this difference. DESIGn 21 HSV-2 seropositive patients, 10 with history of >8 clinical recurrences a year (symptomatics) and 11 without symptoms of genital herpes (asymptomatics) were included. All had to answer a questionnaire. With standardised methods, the skin temperature, pH, and the skin barrier function, expressed as transepidermal water loss (TEWL) and skin capacitance, were measured on labium majus and perineum. Culture for bacteria was performed from the same regions.
No significant differences in terms of pH and skin barrier function were registered between symptomatic and asymptomatic patients. Asymptomatic patients had a tendency (0.06) to a higher colonisation with lactobacilli on labium majus than symptomatic patients.
Skin problems due to the use of absorbent hygiene products, such as diapers, incontinence pads, and feminine sanitary articles, are mostly due to climate or chafing discomfort. If these conditions are allowed to prevail, these may develop into an irritant contact dermatitis and eventually superficial skin infections. Skin humidity and aging skin are among the most significant predisposing and aggravating factors for dermatitis development. Improved product design features are believed to explain the decline in observed diaper dermatitis among infants. Where adult incontinence-related skin problems are concerned, it is very important to apply a holistic perspective to understand the influences due to the individual's incontinence level and skin condition, as well as the hygiene and skin care measures provided. Individuals with frail, sensitive skin or with skin diseases may preferably have to use high-quality products, equipped with superabsorbent polymers and water vapor-permeable back sheets, to minimize the risk of skin complications.
In order to estimate the influence of occlusion and sweating on forearm and vulvar skin surface water loss (SSWL), both were measured simultaneously and continuously for 30 min in 8 healthy women. Vulvar SSWL decreased significantly during the measuring period from 24.9 +/- 5.2 gm-2 h-1 (mean +/- standard error of the mean) in the first 5 min, to 13.4 +/- 1.7 gm-2 h-1 in the last 5 min (p less than 0.05), whereas no significant changes were observed in forearm SSWL. The vulvar SSWL decay curve followed a logarithmic equation of the form y = a*tb. Irregular SSWL increases ('bursts') were observed in vulvar (but not in forearm) skin of 7 out of 8 women. These SSWL bursts were considered to be caused by sweating. The study shows possible causes of systematic errors in vulvar irritation studies. Methods for error reduction are discussed
A major problem with electrical measurements of the capacitance of the skin using the well kwown capacitance method (Corneometer) resides in the fact that the results of this instrument are expressed as arbitrary capacitance hydration units that are not directly related to real electrical units or to the water content of the horny layer. The purpose of this study was to establish a calibration of the capacitance method using a simple in vitro simulation system of the horny layer.
The calibration of capacitance and conductance methods was carried out using cellulose filter papers saturated with water, aqueous solutions and liquids of different dielectric constant (sorption and desorption experiments).
Using this in vitro method, correlations were established between the capacitance values and the quantity of water adsorbed on the filter and with the dielectric constant of the liquid saturating the filter paper. High correlations were observed during sorption and desorption experiments between the capacitance and conductance measurements.
In vitro calibration of the capacitance method is now possible with this simulation model of the horny layer. Furthermore, determination of the range of sensitivity, accuracy, repeatability and depth of detection of the measuring probe of the capacitance and conductance method were carried out.
Incluye bibliografía e índice Reimprisión en 1992.
The effects of prolonged occlusion on the normal microbial skin flora, pH, transepidermal water loss (TEWL) and carbon dioxide emission rate (CDER) were studied. The total average counts before occlusion were 1.8 X 10(2)/cm(2) and increased to 4.5 X 10(6) on day 5. The highest counts were noted on day 4(9.8 X 10(7)/cm(2)). The composition changed: controls comprised of 63% coagulase negative staphylococci, 6% micrococci, 17% diphtheroids and 6% bacilli. After 5 days of occlusion, the percent compositon was: 63% coagulase negative staphylococci, 11% micrococci, 4% diphtheroids, 19% lipophilic diphtheroids and less than 0.003% gram negative rods. The pH of the skin before occlusion was 4.38 and increased to 7.05 on day 5. After 5 days of occlusion TEWL increased from 0.56 mg/cm2/hr to 1.87 mg/cm2/hr and CO2 emmission increased from 25 nl/cm2/min to 118 nl/cm2/min.
In order to identify and define differences in percutaneous absorption and microcirculatory sensitivity between forearm and vulvar skin we studied the response of human forearm and vulvar (labium majus) skin to topical methyl nicotinate (MN) in 11 healthy premenopausal volunteers. MN-induced erythema was assessed by laser Doppler velocimetry (LDV). The following parameters were compared: 1) basal cutaneous blood flow, 2) the time to peak response, 3) the magnitude of LDV peak response, 4) the area under the LDV response-time curve and 5) the decay time to 75% of peak response. Basal cutaneous blood flow at the vulva was higher than at the forearm (P less than 0.05); the magnitude of peak response was lower at the vulva than at the forearm (P less than 0.01); the area under the curve was lower at the vulva than at the forearm (P less than 0.001); the decay time to 75% of peak response was shorter at the vulva than at the forearm (P less than 0.001). The time to peak response showed no significant differences between sites. The results indicate that the MN-induced vasodilatation is less intense and lasts shorter in vulvar compared to forearm skin.
The effect of prolonged drying on transepidermal water loss (TEWL), capacitance and pH of vulvar and forearm skin was studied in 15 healthy female volunteers. A desiccation chamber that absorbed water evaporating from the skin surface was applied to the forearm and labia majora skin daily for 4 days. Skin TEWL, capacitance and pH were measured daily and 4 days after removal of the desiccation chamber at the site of drying and at a symmetrical control site. Under desiccation, TEWL both of forearm and of vulvar skin showed an increase during the first days of drying, followed by a gradual decrease. After 4 days of drying, forearm TEWL was reduced to 91% of the control value, without reaching significance. Vulvar TEWL was significantly reduced to 80% of the control value. Although relative reduction of vulvar TEWL was higher than that of forearm TEWL, the absolute of value of vulvar TEWL after drying remained significantly higher than that of forearm TEWL. Skin capacitance significantly decreased under drying both in forearm and vulvar skin. Skin pH was significantly reduced by drying at the vulva, but not at the forearm. It is concluded that although changes in physiological parameters during drying seem to be more pronounced in vulvar than in forearm skin, differences suggest that the specific properties of vulvar skin are not explained by anatomically related occlusion alone.
The dynamic friction coefficient between skin and a Teflon probe and its correlation with age, body weight, height, transepidermal water loss and skin capacitance was studied in vulvar and forearm skin of 44 healthy female volunteers. The friction coefficient of vulvar skin was 0.66 +/- 0.03 (mean +/- SEM) compared to that of forearm skin of 0.48 +/- 0.01. The difference was highly significant (p less than 0.001). Multiple-regression analysis showed that the vulvar skin friction coefficient was significantly correlated with capacitance as an indicator of stratum corneum hydration (p less than 0.01) but not with age, weight, height or transepidermal water loss. It is concluded that the high friction coefficient of vulvar skin may be due to the increased hydration of vulvar skin. Age-related differences seem to exist for transepidermal water loss and friction coefficient in forearm but not in vulvar skin.
Wearing dry and wet cloth and disposable diaper materials has certain effects on the degree of skin wetness. These, in turn, affect the coefficient of skin friction, the skin's susceptibility to abrasion damage, its permeability, and its support of microbial growth. These effects were explored using an adult model wearing forearm patches. The adult model was validated by comparisons of skin wetness and friction values for infants and adults determined under similar conditions. Skin wetness was proportional to diaper wetness. With increased skin wetness, there were increased coefficients of friction and increased abrasion damage, skin permeability, and microbial growth. Cloth diaper material produced wetter skin than did disposable diaper material at equivalent loadings.
The effect of 8 days skin occlusion on Pityrosporum orbiculare, bacteria, skin PCO2, pH, transepidermal water loss (TEWL), and water content (WC) was studied. P. orbiculare counts increased from a baseline of 2.1 X 10(2)/cm2 to 2.3 X 10(3)/cm2 after 3 days occlusion; bacterial counts increased from 2.9 X 10(3)/cm2 to 1.8 X 10(5)/cm2 after 8 days occlusion. pH increased during occlusion from 5.6 to a maximum at day 3 of 6.7; TEWL increased to a maximum of 11.74 g m-2 h- after 3 days occlusion compared with 4.39 g m-2 h-1 before. P. orbiculare counts, pH, and TEWL were lower at 8 days than at 3 days occlusion. WC and PCO2 remained high after 8 days; relative WC was then 60.6% compared with 52.5% before occlusion; PCO2 was 63.1 mm Hg compared with 53.1 mm Hg before occlusion. The increased levels of these factors may partially explain the higher risk of infection in occluded compared with non-occluded skin.
Transepidermal water loss (TEWL) was measured as a function of skin temperature, using human cadaver skin in modified skin diffusion chambers. A formula was derived to allow conversion of TEWL at any skin temperature to a standard reference temperature. This formula permits more accurate comparison of TEWL within and between subjects.
A reliable method for measurement of regional heat loss is a prerequisite for studies of heat loss in the neonate with different clothing and under varying environmental conditions. In the present study we evaluated methods for measuring regional skin temperature and regional dry heat loss in neonates, and specifically the influence of contact sensors applied to the skin surface. A modified incubator with controlled climate conditions was used as the climate chamber. The operative temperature was measured continuously with a black globe thermometer. Skin temperature was recorded with small-mass contact sensors and their influence on skin temperature was verified by simultaneous measurement with an infrared camera. The correlation was 0.99 and 1 SD within 0.3 degree C from the line of identity. The influence of the regional heat flow meter on skin temperature was also checked with an infrared camera and was found to be neglible.
A clinical study evaluated potential external genital effects associated with the use of sanitary protection. The subjects used either a pad with traditional cellulose absorbent core or one containing cellulose and absorbent gelling material. Assessments included objective (transepidermal water loss, vaginal pH) and semi-quantitative subjective--methods (skin irritation grading, gynaecological inspection). No statistical or clinical significant differences for any of the parameters evaluated between the groups using the two pads, or compared to the non-pad control period, were found. The parameters used to study the effects on the genital area of an external sanitary product appear appropriate. No significant changes were observed for either of the two pads during daily use for two menstrual cycles.
Brevibacterium epidermidis is a major component of the bacterial flora of certain skin surface biotopes, characterized by a comparatively high pH-value. The presence of Brevibacterium epidermidis seems to be linked to the production of malodour. Skin surface pH has been found to be a major factor of bacterial growth on the skin. In order to find out if this might also apply to Brevibacterium epidermidis, this microorganism was grown in vitro in continuous culture using a chemostat. Specific growth rate and density of colony forming units were well correlated. While the organism grew readily from pH 5.5 to 8.5, this was not the case with a pH of 5.0. Thus pH-shifts induced by cosmetic procedures can only prevent unpleasant body odour due to abundant growth of bacteria if the pH-value is decreased to 5.0 or less.
The addition of suspensions of Candida albicans cells under occlusion to the left and right forearms, buffered at 2 different pH levels (6.0 and 4.5), resulted after 24 h in unilateral or bilateral lesions in 14 of 15 volunteers. The resulting skin-surface pH was 5.7+/-0.3 and 5.1+/-0.2, respectively. The lesions were more pronounced on the arm with the higher pH in all 14 subjects who reacted. In 11 cases, reactions occurred only on the arm with the higher pH. The pH-induced results are not due to inhibited growth of C. albicans. They may be due to a pH dependence of the yeast's virulence capacity and/or a modulation of the host's defence ability. The use of skin-occlusive products (e.g. dressings, diapers and panty liners) is known to raise skin pH and is associated with skin infections of C. albicans. An acidic buffer incorporated in such products could be a preventive measure for Candida-induced skin rash.
Infants wearing breathable disposable diapers experienced significantly less diaper dermatitis (DD) compared to infants wearing standard, nonbreathable disposable diapers in a series of double-blind clinical trials. Severe DD, including confirmed infection with Candida albicans, was reduced by 38-50% among infants wearing highly breathable (HB) diapers. The prevalence of DD was inversely related to the breathability of the garments. The inhibitory effect of breathable diapers on the survival of Candida was further confirmed in controlled experiments with adult volunteers. A suspension of C. albicans cells was applied to delineated sites on the volar forearm. Each site was then covered by a full-thickness patch from either an HB or a standard diaper. Survival of Candida colonies was reduced by almost two-thirds in the breathable diaper-covered sites compared to the control sites.
Skin occlusion is a condition encountered with various articles as part of everyday life and resulting changes in skin barrier physiology often remain unnoticed. In the present study we aimed to understand the impact of absorbent feminine hygiene articles, one vapor-permeable and one vapor-impermeable, on skin hydration in response to exposure time and different environmental climatic conditions. Using a forearm model, volunteers were patched with moistened vapor-permeable and -impermeable articles in parallel for 1, 3, and 6 h and under different climatic conditions (i.e. 20 degrees C/30% relative humidity, 25 degrees C/50% relative humidity, 30 degrees C/ 75% relative humidity). The physiological changes in the skin barrier function were measured via skin hydration, evaporation of superficial water (skin surface water loss, SSWL) and relative humidity in the microclimate between skin and occlusive article (RH(mc)). The results show that skin hydration, SSWL, and RH(mc) under a vapor-permeable article are reduced versus the vapor-impermeable article for all exposure times at 25 degrees C and 50% relative humidity. SSWL and RH(mc) decrease from their 1-hour peak values with increasing exposure time, while skin hydration decreases only after 3 h of exposure. Lower environmental temperature (20 degrees C) and lower relative humidity (30%) have little impact on the reduction of SSWL and RH(mc,) but more so on the reduction of skin hydration. Higher temperature (30 degrees C) and higher relative humidity (75%) increase RH(mc) and skin hydration under both vapor-permeable and -impermeable articles while SSWL is reduced under the vapor-impermeable article under these conditions. In conclusion, vapor-permeability is the key factor for physiological changes in the barrier function of the skin under occlusion, exposure time and climatic conditions being modulating factors. These findings have been integrated into a model of skin hydration under occlusion in the context of absorbent hygiene articles. While current vapor-impermeable articles are effective in reducing the excessive moisture on the skin due to bodily discharge, vapor permeability adds a further measurable benefit in reducing skin overhydration.
Physiologie der Haut der Vulva: neue Aspekte
- P Elsner
- Ha Oriba
- Maibach
Elsner P, Oriba HA, Maibach HI. Physiologie der Haut der Vulva: neue Aspekte. Hautarzt 1989; 40: 411 – 417.
A refined method to evaluate diapers for effectiveness in reducing skin hydration using the adult forearm The vulva skin microclimate 91 Acta Derm Venereol 83 13 Transepidermal water loss as a function of skin surface temperature
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The human skin microflora Medical importance of the normal microflora
- Wc Noble
Noble WC. The human skin microflora. In: Tannock
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International patent publication number WO 99
- G Carlucci
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99/49824.