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Background: Besides being a potential component of (some species of) colophonium, D-limonene is also used as a tackifier in the production of adhesives. Hydroperoxides of limonene are well-known skin sensitizers., Objectives: To show that D-limonene may be present in colophonium-containing but also colophonium-free ("hypoallergenic") adhesives, and that patients suffering from allergic contact dermatitis (ACD) from both types of adhesives might display positive patch test reactions to limonene hydroperoxides in this regard., Methods: Five patients with suspected ACD from adhesives were patch tested to the baseline series (containing limonene hydroperoxides 0.3 and 0.2% pet.), additional series and, if available, to the culprit adhesives. The adhesives labelled as containing colophonium (n = 3) or free from it (n = 2) were analysed with gas chromatography - mass spectrometry (GC-MS) for the presence of D-limonene., Results: All five patients sensitised to adhesives had (strong) positive patch test reactions to limonene hydroperoxides. The presence of D-limonene, and/or related components, could be demonstrated in all three colophonium-containing and, surprisingly, also in two colophonium-free ("hypoallergenic") tapes., Conclusions: D-limonene may be present in both regular and "hypoallergenic" adhesives, with limonene hydroperoxides potentially contributing to ACD from such medical devices. The use of fragrance chemicals in adhesives deserves further research., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: Adhesive tape is commonly used to secure endotracheal tubes (ETT) during general anaesthesia. Although a variety of adhesives are used in practice, few studies have investigated the likelihood of different adhesives in producing facial skin injury. Given that differences in cost exist between adhesives that are often used interchangeably, it would be prudent to use the most economical option., Material and Methods: A single-centre, prospective, randomised controlled non-inferiority trial of patients undergoing general anaesthesia with an ETT was conducted. Patients were randomised in a blinded fashion to use Durapore (DP) on either the right or left side of the face to secure the ETT, with Hy-Tape (HT) on the contralateral side. Skin photographs were taken prior to tape application and following tape removal. These were evaluated by three dermatologists to determine presence or absence of facial skin erythema, scaling, oedema, and tearing. Differences were compared using McNemar's test. For outcomes analysis, a non-inferiority margin of 20% difference was used with respect to the 95% CI., Results: Among 112 patients, 33.0% were male, with a mean (SD) age of 55.6 (15.9) years. Comparing DP vs. HT, noninferiority was demonstrated in the patients with skin erythema (1.8% difference, 95% CI: -5.6 to 9.2, P = 0.79), oedema (3.6% difference, 95% CI: -2.8 to 10.0%, P = 0.34), scaling (5.4% difference, 95% CI: -4.1 to 14.8, P = 0.31), and tearing (0.9% difference, 95% CI: -5.2 to 7.3, P > 0.99)., Conclusions: There is a non-inferior difference in the proportion of patients with facial skin erythema after use of DP vs. HT to secure the ETT.

Tape products containing ketoprofen have transdermal analgesic and anti-inflammatory effects. We compared the physicochemical properties (water-vapor permeability, peel force, peel force-time curve) between one brand-name product and eight generic products. Regarding the measurement of water-vapor permeability, the formulations using methacrylic acid n-butyl acrylate copolymer (MBA) adhesives showed higher water-vapor permeability than those using styrene isopropyl styrene block copolymer (SIS) adhesives. In the case of the formulation using SIS adhesive, the central part of the formulation had higher water-vapor permeability than both ends. In the 90-degree peel test using the methods of adhesion testing, significant differences were observed between the products, especially as the various application times (5 min, 30 min, 9 h and 24 h) increased. This may be because the longer the time of attachment to the adherend, the more the adhesive force with the adherend increased due to the "anchoring effect" of the adhesive. The measurement of the peel force-time curve showed different curves among the products, especially in the peel force curve of Teikoku after 24 h, which showed two characteristic peak curves. Furthermore, when the peel forces at 25°C and 40°C were compared, Mohrus and Toko showed significantly higher values at 40°C compared to 25°C. This study showed that there are many generic drugs with formulation characteristics different from those of brand-name drugs, and that there is a large difference among the products in terms of adhesion and detachment.

Postoperative complications can be burdensome on both the patient and the surgeon. Attention in literature is often directed toward different forms of treatment and successful outcomes in surgery. The incentive of this article is to bring insight toward postoperative complications in rearfoot surgery, more specifically, the repair of the Achilles tendon with suture tape and suture anchors. This article directs attention to the recent reports on hypersensitivity reactions seen with the use of suture tape and nonabsorbable suture anchors and may encourage physicians to make patients aware of this potential complication when using these materials., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The number of patients with contact dermatitis from glucose sensors and insulin infusion sets is increasing. Patch testing is challenging because of a lack of information concerning the constituent materials of medical devices., Objectives: To report on products and causes of allergic reactions to glucose sensors or insulin infusion sets over a 5-year period and suggest a short screening series., Methods: Analysis of patch test data from consecutive patients suspected of allergic contact dermatitis (ACD) to glucose sensors and/or insulin infusion sets from 2015-2019., Results: Patient numbers increased from 4 to 15 per year; 30/38 (78.9%) were children. In 29 (76.3%), a diagnosis of allergic/probable ACD was established, mostly due to the tapes of the device or allergens in these tapes (n = 23) followed by allergens in the device housing (n = 10). Isobornyl acrylate, abitol, and colophonium were the most common allergens. Information from manufacturers was often difficult to obtain and, if accessible, inadequate. For this reason, the diagnosis was delayed for more than 1.5 years in 12 (31%) patients., Conclusions: The increasing number of patients, mostly children, with ACD from devices used in treatment of type 1 diabetes demonstrates the importance of this problem. Allergies can easily be overlooked, due to the lack of mandatory labeling of the constituent materials of the devices., (© 2020 John Wiley & Sons A/S . Published by John Wiley & Sons Ltd.)

The focus of this study was to test the hypothesis that there would be no difference between the biocompatibility of cyanoacrylate-based adhesives in rat subcutaneous tissues. In total, 60 male Wistar rats were used, and divided into four groups (n = 15): Group C (control, PVA-polyvinyl alcohol sponge), Group NO (N-butyl-2-octylcyanoacrylate), Group NH (n-hexyl-cyanoacrylate), and Group EC (Ethyl-cyanoacrylate). The animals were sacrificed after time intervals of 7, 15, and 30 days and tissues were analyzed under optical microscope as regards the events of inflammatory infiltrate, edema, necrosis, granulation tissue, giant cells, young fibroblasts, and collagen formation. The results were statistically analyzed by the Kruskal-Wallis and Dunn tests (p < .05). Significant inflammatory infiltrate was shown for all the adhesives in the time intervals of 7 (p = .004) and 15 days (p = .003). In the time interval of 30 days, moderate inflammatory infiltrate was observed in Groups NH and EC, with significant difference from Control (p = .001). The quantity of collagen fibers in all the experimental groups showed significant difference compared with Control in the time intervals of 7 (p = .002) and 15 days (p = .001), at 30 days only Group EC showed a smaller quantity of collagen fibers in comparison with Control (p = .001). The hypothesis was rejected. The adhesive N-butyl-2-octylcyanoacrylate had less influence on the inflammatory intensity of multinucleated giant cells. Ethyl-cyanoacrylate demonstrated the lowest level of biocompatibility among the adhesives, but its use in clinical practice may be promising for coaptation of smaller edges of superficial tissue. Surgical adhesives were shown to be feasible for clinical use in substitution of conventional suturing. Ethyl-cyanoacrylate should be used with caution due to its greater influence on tissues., (© 2019 Wiley Periodicals, Inc.)

Background: The optimal securement method of endotracheal tubes is unknown but should prevent dislodgement while minimizing complications. The use of an endotracheal tube fastener might reduce complications among critically ill adults undergoing endotracheal intubation., Methods: In this pragmatic, single-center, randomized trial, critically ill adults admitted to the medical intensive care unit (MICU) and expected to require invasive mechanical ventilation for greater than 24 h were randomized to adhesive tape or endotracheal tube fastener at the time of intubation. The primary endpoint was a composite of any of the following: presence of lip ulcer, endotracheal tube dislodgement (defined as moving at least 2 cm), ventilator-associated pneumonia, or facial skin tears anytime between randomization and the earlier of death or 48 h after extubation. Secondary endpoints included duration of mechanical ventilation and ICU and in-hospital mortality., Results: Of 500 patients randomized over a 12-month period, 162 had a duration of mechanical ventilation less than 24 h and 40 had missing outcome data, leaving 153 evaluable patients randomized to tube fastener and 145 evaluable patients randomized to adhesive tape. Baseline characteristics were similar between the groups. The primary endpoint occurred 13 times in 12 (7.8%) patients in the tube fastener group and 30 times in 25 (17.2%) patients in the adhesive tape group (p = 0.014) for an overall incidence of 22.0 versus 52.6 per 1000 ventilator days, respectively (p = 0.020). Lip ulcers occurred in 4 (2.6%) versus 11 (7.3%) patients, or an incidence rate of 6.5 versus 19.5 per 1000 patient ventilator days (p = 0.053) in the fastener and tape groups, respectively. The endotracheal tube was dislodged 7 times in 6 (3.9%) patients in the tube fastener group and 16 times in 15 (10.3%) patients in the tape group (p = 0.03), reflecting incidences of 11.9 and 28.1 per 1000 ventilator days, respectively. Facial skin tears were similar between the groups. Mechanical ventilation duration and ICU and hospital mortality did not differ., Conclusion: The use of the endotracheal tube fastener to secure the endotracheal tubes reduces the rate of a composite outcome that included lip ulcers, facial skin tears, or endotracheal tube dislodgement compared to adhesive tape., Trial Registration: ClinicalTrials.gov NCT03760510. Retrospectively registered on November 30, 2018.

Neonates at the neonatal intensive care unit (NICU) are at high risk for procedural pain exposure. This study describes the type and frequency of procedures in neonates admitted to University Intensive Care Unit. This was a prospective cohort study of 150 neonates admitted to the NICU during the first 7 days of life at a governmental hospital. The type and frequency of procedures were evaluated using a tool which included the type and number of procedures performed per shift. A total of 14,008 painful procedures were performed on neonates with an average of 97.11 painful procedures per baby and 13.9/day for each baby. Adhesive removal (21.3%) was the most frequently performed procedure. The number of painful procedures was inversely correlated with gestation age ( p < .001) and birth weight ( p < .001). The number of painful procedures performed on neonates is high, particularly for neonates with small gestational age and low birth weight babies.

Background: Surgical site infection has considerable cost implications for healthcare providers. Evidence suggests that the use of Micropore™ tape as a dressing for surgical incisions may be associated with reduced/comparable rates of infection in surgical wounds. 3M™ Micropore™ tape is significantly cheaper than conventional wound dressings. The purpose of this study was to compare differences in the rate of wound healing problems including superficial incisional surgical site infection (SSI) and wound healing problems following cosmetic breast procedures between Micropore™ tape and other common wound dressings., Methods: A clinical database was utilised to identify all patients undergoing elective breast surgery at a UK private cosmetic surgery group between May and November 2017. The patients were divided into 2 groups: those whose wounds were dressed with 3M™ Micropore™ tape post-operatively and those dressed with other common wound dressings. Data was analysed to assess the prevalence of post-operative wound healing problems (superficial incisional surgical site infection and delayed wound healing) in each group., Results: 1216 patients were identified in our database, 659 patients receiving Micropore™ and 557 patients receiving conventional wound dressings. The overall prevalence of wound healing problems in the Micropore™ tape and conventional wound dressing group were 12% and 10% respectively, with no statistical difference (p = 0.3913). There was no statistical significance between the use of antibiotics and prevalence of wound healing problems in either group., Conclusion: The results of our study suggest that there is no difference between the use of Micropore™ tape and other conventional wound dressings in the prevalence of post-operative wound healing problems in cosmetic breast surgery. Our findings support the routine use of Micropore™ tape in post-operative dressing for clean, non-contaminated, directly closed, elective surgical wounds. We suggest a larger scale, prospective, randomized study should be conducted to confirm these initial findings., (Copyright © 2018. Published by Elsevier Ltd.)

Aims: To compare outcomes of the retropubic versus the transobturator tension-free vaginal tape (TVT vs TVT-O) at 5 years., Methods: A total of 569 women undergoing surgery for primary stress incontinence were randomized to receive a retropubic or a transobturator tensionfree vaginal tape (TVT or TVT-O). Follow-up at 5 years included clinical examination, urodynamic studies and quality of life. The primary outcome measure was continence defined as a negative cough stress test at a volume of 300 mL. Secondary outcomes included urodynamic parameters, complications and quality of life.ClinicalTrials.gov (NCT 0041454)., Results: Three hundred and thirty-one patients (59%) were evaluated at 5 years (277 were seen, examined and completed questionnaires; 54 only completed questionnaires). No significant differences were seen in rates of a negative cough stress test (83% vs 76%, respectively), urodynamic parameters and complications. Quality-of-life improved significantly in both groups, without significant differences between the groups. Erosion rates were 5.2% and 4.5%, and reoperation rates were 4.1% and 3.2% respectively., Conclusions: At 5 years, subjective and objective results after TVT and TVT-O are stable and similar, without statistical significant differences between the procedures. Major long-term problems appear rare., (© 2017 Wiley Periodicals, Inc.)

Facial burns are extremely common in the burn population, as is the need for endotracheal intubation. However, securing the endotracheal tube in these patients can be difficult. Our institution's historically preferred method of securing tubes with twill tape was effective but had a high rate of device-related pressure ulcers. The introduction of new silicone pressure-reducing strips for use in conjunction with twill tape was effective in reducing the incidence of pressure ulcers in this patient population from 21% to 5% (P = .032).

Objective: Social support is known to reduce the negative effects of stress on health, but there is mixed evidence for the effects of social support on wound healing. This study aimed to investigate whether undergoing a task designed to promote social closeness with a fellow participant and being paired with that person during a tape-stripping procedure could reduce stress and improve skin barrier recovery compared to going through tape stripping alone., Method: Seventy-two healthy adults were randomized to either a social closeness condition where participants completed a relationship-building task and tape stripping in pairs or a control condition where they completed tape stripping alone. Skin barrier recovery was measured using transepidermal water loss. Salivary cortisol and alpha-amylase were collected at four time points as markers of the endocrine and autonomic stress response., Results: Social closeness had a beneficial effect on skin barrier recovery compared to the control condition, t(54) = 2.86, p = .006, r = .36. Social closeness significantly reduced self-reported stress. The effects of the intervention on skin barrier recovery were moderated by self-reported stress reduction (p = .035). There were no significant differences in cortisol between groups, but alpha-amylase increased significantly more from baseline to after tape stripping in the control group compared to the intervention group., Conclusions: This is the first study to show that social closeness with a person going through a similar unfamiliar procedure can positively influence wound healing. Future research needs to replicate these findings in other wound types and in clinical settings. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

A medical adhesive can be defined as a product used to secure a device (ie, tape, dressing, catheter, electrode, and ostomy pouch) to the skin. Skin injury related to medical adhesive usage occurs across all care settings with medical adhesive-related skin injuries (MARSIs) playing a significant role with patient safety. The purpose of this descriptive prospective study was to assess all adult patients with wounds seen in the vascular clinic for MARSI by the CWOCN NP over a 3-month time period. One hundred twenty patients comprising a total of 207 visits were seen by the CWOCN NP over the 3-month time frame. Seven patients presented to the clinic from home with MARSI for a frequency of 5.8%. There were four males and three females with ages ranging from 52 to 83 years with a mean age of 67.7 years. All patients had a diagnosis of peripheral vascular disease with MARSI present on the lower extremities. Six of the seven MARSI cases were related to having paper tape removed from the periwound skin at home resulting in epidermal stripping either by the home health care professional (N = 4) or by the patient themselves (N = 2). The other MARSI was related to tension blister from steri-strips applied with benzoin by health care professional on a lower leg incision. Patients were unclear as far as when these injuries had occurred and often remarked that they thought that tape injuries were unpreventable. There is a need for additional research studies examining MARSI frequency across care settings such as the vascular population to identify those at risk and then implement measures to prevent it., (Copyright © 2017 Society for Vascular Nursing, Inc. Published by Elsevier Inc. All rights reserved.)

Objectives: To systematically review the current evidence on the anatomic and functional outcomes in women undergoing laparoscopic hysteropexy., Study Design: An electronic database search was undertaken (2000-2016). Keywords were: "laparoscopy", "hysteropexy", "cervicopexy", "uterine suspension", "uterosacral plication". References of identified studies as well as abstracts from conferences were considered. We restricted the search to humans, female patients and currently used surgical procedures. Studies with ≥5 cases in English language and published in 2000 or later, were included. After the initial yield, studies were selected following title screening, abstract and full text scrutiny., Results: A total of 17 studies were deemed suitable for inclusion in the review. A total of 770 patients in 17 studies received the intervention being studied (laparoscopic hysteropexy) and were assessed post-operatively with pooled success rates of 85.32% (95%CI: ±2.5). Laparoscopic suture hysteropexy has pooled success of 70.5% (95%CI:±5.33) whereas the pooled success of the suspension to the sacral promontory using mesh or tape is 92% (95%CI: ±2.53). One small study on suspension to the anterior abdominal wall (28 cases) and one to the pectineal ligament (18 cases) have shown 96.4% (95%CI:±6.9) and 94.5% (95%CI:±10.53) objective success rates respectively., Conclusion: Laparoscopic hysteropexy was associated with good anatomic cure rates of greater than 90% in majority of the studies. There was an improvement in symptoms, and good subjective cure rates in 73%-100% of the patients. Reoperation rates were low in most studies ranging from around 0%-28%. Complications rates were generally low. Laparoscopic hysteropexy is a feasible alternative for women needing surgical correction of uterovaginal prolapse and who desire conservation of the uterus., (Crown Copyright © 2016. Published by Elsevier Ireland Ltd. All rights reserved.)

Background: Endotracheal tube security is a critical safety issue. We compared the mobility of an in situ endotracheal tube secured with adhesive tape to the one secured with a new commercially available purpose-designed endotracheal tube-holder device (Haider Tube-Guard). We also observed for the incidence of oropharyngeal or facial trauma associated with the 2 tube fixation methods., Methods: Thirty adult patients undergoing general anesthesia with neuromuscular blockade were prospectively enrolled. Immediately after intubation, a single study author positioned the endotracheal tube tip in the distal trachea using a bronchoscope. Anesthesiologists caring for patients secured the tube in their normal fashion (always with adhesive tape). A force transducer was used to apply linear force, increasing to 15 N or until the principal investigator deemed that the force be aborted for safety reasons. The displacement of the endotracheal tube was measured with the bronchoscope. Any tape was then removed and the endotracheal tube secured with the Haider Tube-Guard device. The linear force was reapplied and the displacement of the endotracheal tube measured. The Haider Tube-Guard device was left in place for the duration of the case. The patient's face and oropharynx were examined for any evidence of trauma during surgery and in the recovery room. On discharge from the postanesthesia care unit, the patient answered a brief survey assessing for any subjective evidence of minor facial or oropharyngeal trauma., Results: Under standardized tension, the endotracheal tube withdrew a mean distance of 3.4 cm when secured with adhesive tape versus 0.3 cm when secured with the Haider Tube-Guard (P <0.001). Ninety-seven percent of patients (29/30) experienced clinically significant endotracheal tube movement (>1 cm) when adhesive tape was used to secure the tube versus 3% (1/30) when the Haider Tube-Guard was used (P <0.001). Thirty percent of patients (9/30) were potentially deemed a high extubation risk (endotracheal tube movement >4 cm) when the endotracheal tube was secured with tape versus 0% (0/30) when secured with the Haider Tube-Guard (P = 0.004). Six patients with taped endotracheal tubes required the traction to be aborted before 15 N of force was achieved to prevent potential extubation as the tape either separated from the face or stretched to allow excessive endotracheal tube movement. None of the patients appeared to sustain any injury from the Haider Tube-Guard device., Conclusions: The Haider Tube-Guard significantly reduced the mobility of the endotracheal tube when compared with adhesive tape and was well tolerated in our observations.

Purpose: Acute radiation dermatitis (ARD) is one of the most common adverse events of proton beam therapy (PBT), and there is currently no effective method to manage ARD. The purpose of this study was to examine the prophylactic effect of a film dressing using Airwall on PBT-induced ARD compared with standard skin managements., Methods and Materials: A total of 271 patients with prostate cancer who were scheduled for PBT at our center were divided into 2 groups based on their own requests: 145 patients (53%) chose Airwall (group A) and 126 patients (47%) received standard treatments (group B). We evaluated irradiated skin every other day during PBT and followed up once a week for a month after completion of PBT., Results: Grade 0, 1, 2, and 3 dermatitis were seen in 2, 122, 21, and 0 and 0, 65, 57, and 4 patients in groups A and B, respectively (P<.001). Numbers of days to grades 1 and 2 ARD development were 34.9 ± 14.3 and 54.7 ± 10.3 and 31.8 ± 11.3 and 54.4 ± 11.6 in groups A and B, respectively. There were no significant differences between the 2 groups. Eighteen patients (12%) in group A who experienced problems in the region covered with Airwall switched to standard skin care after peeling the film off., Conclusions: Film dressing using Airwall reduced the severity of ARD without delaying the response time of the skin to proton beam irradiation compared with standard skin management. Hence, film dressing is considered a promising measure for preventing ARD secondary to PBT., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: People admitted to intensive care units and those with chronic health care problems often require long-term vascular access. Central venous access devices (CVADs) are used for administering intravenous medications and blood sampling. CVADs are covered with a dressing and secured with an adhesive or adhesive tape to protect them from infection and reduce movement. Dressings are changed when they become soiled with blood or start to come away from the skin. Repeated removal and application of dressings can cause damage to the skin. The skin is an important barrier that protects the body against infection. Less frequent dressing changes may reduce skin damage, but it is unclear whether this practice affects the frequency of catheter-related infections., Objectives: To assess the effect of the frequency of CVAD dressing changes on the incidence of catheter-related infections and other outcomes including pain and skin damage., Search Methods: In June 2015 we searched: The Cochrane Wounds Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. We also searched clinical trials registries for registered trials. There were no restrictions with respect to language, date of publication or study setting., Selection Criteria: All randomised controlled trials (RCTs) evaluating the effect of the frequency of CVAD dressing changes on the incidence of catheter-related infections on all patients in any healthcare setting., Data Collection and Analysis: We used standard Cochrane review methodology. Two review authors independently assessed studies for inclusion, performed risk of bias assessment and data extraction. We undertook meta-analysis where appropriate or otherwise synthesised data descriptively when heterogeneous., Main Results: We included five RCTs (2277 participants) that compared different frequencies of CVAD dressing changes. The studies were all conducted in Europe and published between 1995 and 2009. Participants were recruited from the intensive care and cancer care departments of one children's and four adult hospitals. The studies used a variety of transparent dressings and compared a longer interval between dressing changes (5 to15 days; intervention) with a shorter interval between changes (2 to 5 days; control). In each study participants were followed up until the CVAD was removed or until discharge from ICU or hospital. Confirmed catheter-related bloodstream infection (CRBSI)One trial randomised 995 people receiving central venous catheters to a longer or shorter interval between dressing changes and measured CRBSI. It is unclear whether there is a difference in the risk of CRBSI between people having long or short intervals between dressing changes (RR 1.42, 95% confidence interval (CI) 0.40 to 4.98) (low quality evidence). Suspected catheter-related bloodstream infection Two trials randomised a total of 151 participants to longer or shorter dressing intervals and measured suspected CRBSI. It is unclear whether there is a difference in the risk of suspected CRBSI between people having long or short intervals between dressing changes (RR 0.70, 95% CI 0.23 to 2.10) (low quality evidence). All cause mortalityThree trials randomised a total of 896 participants to longer or shorter dressing intervals and measured all cause mortality. It is unclear whether there is a difference in the risk of death from any cause between people having long or short intervals between dressing changes (RR 1.06, 95% CI 0.90 to 1.25) (low quality evidence). Catheter-site infectionTwo trials randomised a total of 371 participants to longer or shorter dressing intervals and measured catheter-site infection. It is unclear whether there is a difference in risk of catheter-site infection between people having long or short intervals between dressing changes (RR 1.07, 95% CI 0.71 to 1.63) (low quality evidence). Skin damage One small trial (112 children) and three trials (1475 adults) measured skin damage. There was very low quality evidence for the effect of long intervals between dressing changes on skin damage compared with short intervals (children: RR of scoring ≥ 2 on the skin damage scale 0.33, 95% CI 0.16 to 0.68; data for adults not pooled). PainTwo studies involving 193 participants measured pain. It is unclear if there is a difference between long and short interval dressing changes on pain during dressing removal (RR 0.80, 95% CI 0.46 to 1.38) (low quality evidence)., Authors' Conclusions: The best available evidence is currently inconclusive regarding whether longer intervals between CVAD dressing changes are associated with more or less catheter-related infection, mortality or pain than shorter intervals.

Background: Bilayered suture repairs have become the standard of care in dermatologic surgery. However, the benefit of superficial sutures for fine epidermal alignment on high-tension areas remains unclear., Objective: To compare the overall cosmetic outcome of traditional epidermal sutures with adhesive strips in layered dermatologic repairs on the back., Methods: A total of 10 patients underwent standard elliptical excision on the back followed by subcutaneous closure with 4-0 polyglactin 910 buried sutures. Each half of the wound was then randomized to either 4-0 polypropylene running sutures or 1/4″ Steri-Strip films for epidermal approximation. Postoperative evaluations were completed in person at 2 weeks, 3 months, and 6 months using the Patient and Observer Scar Assessment Scale., Results: The adhesive strip group had superior appearance and greater patient satisfaction at 2 weeks. Evaluation at 3 months and 6 months revealed no statistically significant difference in overall scar cosmesis., Conclusion: Adhesive strips result in equivalent long-term scar outcome when compared with traditional epidermal sutures and should be viewed as a time-saving alternative in layered dermatologic repairs on the back. This finding further corroborates that undermining and placement of deep buried sutures are the primary determinants of wound appearance.

Objectives: To investigate Toll-like receptor activation in human skin using tape stripping and imiquimod cream challenges in healthy volunteers., Subjects, Treatment and Methods: Seventeen male Caucasian subjects underwent a baseline biopsy on their lower back prior to two tape stripping procedures 7 days apart. Subjects were then treated with 5% imiquimod for 2 and 4 days on separate sites in the same area. Further biopsies were taken 22-24 h after each challenge and mRNA and microRNA extracted and expression values analysed using robust statistical and pathway analysis methods., Results: Fifteen of the 17 subjects completed the study according to protocol. No adverse events were associated with the procedures. A significant change (p < 0.05, fold change >1.5 or <-1.5) in mRNA expression of 7,996 genes was evident in biopsies taken at both time points post tape stripping, compared to baseline biopsy expression values. The induction of mRNAs involved in various pathways including adhesion and migration was evident. mRNA markers representing inflammatory cells [e.g., CD14, CD3E (p < 0.0001)] and mRNAs encoding genes regulated by type 1 interferon (IFN) [e.g., MX1, OAS1and CXCL10 (p < 0.0001)] were significantly up-regulated. IFNα and CXCL10 proteins were detectable in exudates released 1 and 4 h post tape stripping. A putative signalling network associating these transcripts and six microRNAs (hsa-miR, -31, -132, -155, 548c, 548n and 574) was identified using a meta-regulation network model. microRNAs not previously associated with IFN signalling have been identified. In contrast, only 223 known transcripts were significantly changed after imiquimod treatment, including CXCL10, and OAS1., Conclusion: Results suggest that IFN signalling is important in these translational models and novel miRNA may be new targets in the treatment of IFN associated skin disease.

Background: Adverse dermatologic reactions to tapes are a common problem in the medical field and can delay or alter patient care, but their prevalence, etiology, and management are poorly defined., Objective: The aims of this study were to make a distinction between true allergy and nonallergic tape reactions (NATRs) to medical tapes and to make recommendations for dermatologists in the approach to each., Methods: We performed a cross-sectional analysis of the electronic medical record database at a large hospital system and a review of literature., Conclusions: Although tape allergy is reported by 0.3% of patients, true tape allergies are rare. More commonly, patients experience NATRs. True tape allergy and NATR are mechanistically distinct and can be distinguished from each other based on history. The approach to management of each is distinct.

Clinical trials successfully using antibodies targeting IL-17 in psoriasis support the importance of IL-17 in the pathophysiology of this disease. However, there is a debate concerning the source and dynamics of IL-17 production in inflamed skin. Here we characterized IL-17-producing immune cells over time, using two established in vivo models of human skin inflammation that share many histological features with psoriasis, i.e., leukotriene B4 application and tape-stripping. Both treatments revealed a clear influx of neutrophils and T cells. Staining for IL-17 revealed that the majority of IL-17 was expressed by neutrophils and mast cells, in both models. Neutrophils, but not mast cells, coexpressed the IL-17-associated transcription factor RORγt and were able to form extracellular traps. While the presence of mast cells remained steady during the skin inflammatory process, the presence of neutrophils was clearly dynamic in time. Therefore, it is attractive to hypothesize that IL-17+/RORγt+ neutrophils contribute to human skin inflammation in vivo and possibly to the pathogenesis of skin diseases such as psoriasis. Surprisingly, T cells represented a minority of the IL-17-expressing cell population. These observations challenge the classical opinion that IL-17 is predominantly associated with T cells in skin inflammation.

Background: Retropubic hematomas may complicate up to 4.1% of tension-free vaginal tape (TVT) procedures in the surgical treatment of stress urinary incontinence. Symptomatic or expanding hematomas often require intervention, usually accomplished through an abdominal incision., Case: A 43-year-old woman underwent transvaginal management of venous bleeding and evacuation of a 1500-mL retropubic hematoma after a TVT Secur or "mini-sling" procedure., Conclusions: Significant bleeding can complicate even the least invasive surgical approach to treat stress urinary incontinence. Transvaginal evacuation of a symptomatic retropubic hematoma with instillation of a hemostatic agent may be a safe alternative to laparotomy in a hemodynamically stable patient.

Background/purpose: Adhesive barriers secure medical devices to skin. Laboratory adhesion models are not predictive of in vivo performance. The objectives of these studies were to validate a novel peel force device, and to investigate relationships between barrier formulations, barrier width, subjective discomfort during barrier removal, and substrates., Methods: Three hydrocolloid barrier formulations in three widths were adhered to ethylene/methyl acrylate film (EMA), VITRO-SKIN(®) and human abdominal skin. Peel force was measured using a MTS Insight™ and a cyberDERM Inc. Mini Peel Tester (CMPT). Subjects reported their discomfort., Results: Peel forces were highly correlated between devices and highly dependent on substrate. Data suggested a weak direct association between peel force in vivo and discomfort. The 0.5″-wide barriers had the most precise peel forces measurements in vivo. A weak negative relationship between normalized peel force and barrier width on human skin was found. There was a strong positive relationship between peel force in vivo and on EMA, whereas no correlation was observed with VITRO-SKIN(®)., Conclusion: The CMPT correlates with a standard instrument and can advantageously investigate adhesion in vivo. Barrier width and substrate impact the reliability and predictability of peel force measurements., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Adenosine 5'-triphosphate (ATP) release from keratinocytes has been observed in various stress models in vitro, but studies demonstrating epidermal ATP release in vivo are limited. To visualize extracellular ATP (eATP) in vivo, we developed enhanced green-emitting luciferase immobilized on agarose beads (Eluc-agarose). Subcutaneous injection of Eluc-agarose together with ATP into the dorsal skin of BALB/c mice following intraperitoneal luciferin injection produced detectable and measurable bioluminescence using an in vivo imaging system. Using Eluc-agarose, we demonstrated in vivo that bright bioluminescence was observed from 1 to 20 minutes after repeated tape stripping of murine skin. This bioluminescence was suppressed by the local administration of apyrase. Eluc-agarose bioluminescence was observed only in tape-stripped skin with transepidermal water loss (TEWL) between 100 and 140 g m(2) h(-1), indicating a loss of bioluminescence with excessive tape stripping (TEWL>140 g m(-2) h(-1)). Histologically, tape-stripped skin with detectable eATP had a viable epidermis and a subepidermal neutrophil infiltrate, and administration of apyrase reduced the inflammatory infiltrate. Neither a viable epidermis nor an upper dermal neutrophil infiltrate was observed after excessive tape stripping. These results suggest that tape stripping prompts ATP release from viable keratinocytes, which facilitates inflammatory cell migration. Eluc-agarose may be useful in the in vivo detection of eATP in murine models of skin diseases.

Purpose: The optimal approach for removing surgical materials that have penetrated the bladder is still debatable. We reviewed our initial experience with transvesical (percutaneous intraluminal access) laparoendoscopic single site surgery to treat such complications. We determined the safety, efficacy and morbidity of the procedure., Materials and Methods: In this case series study 9 women 24 to 63 years old were operated on from November 2009 to July 2012 due to bladder tape/mesh or surgical suture extrusion using the transvesical (percutaneous intraluminal access) laparoendoscopic single site surgery approach. We used the TriPort™ or TriPort+ single site access system, and a combination of straight and articulating or only standard laparoscopic instruments. A running V-Loc™ suture was placed as needed. In all cases followup included urine tests, abdominal ultrasound and cystoscopy., Results: Mean operative time was 59 minutes (range 35 to 105). Median postoperative hospital stay was 2.4 days. No blood loss or complications were observed except 1 conversion to open surgery because of a perivesical abscess. No extra port was added. No adverse events related to the method were observed during the mean 19-month followup. In 1 patient mesh extrusion recurred after 12 months of followup., Conclusions: We consider this technique to be an efficient, safe procedure and a valuable minimally invasive treatment option for foreign body removal from the bladder. However, further observations are needed to prove the validity of the method., (Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Purpose: To establish a model of standardized acute barrier disruption, investigate the response of normal human to repeated tape stripping, and analyze the change of damaged skin with non-invasive examination techniques for skin, such as TEWL and squamometry., Methods: Repeated tape stripping with corneofix was applied on three different anatomical sites; the measurement of TEWL was performed on the baseline and after every 5 strips. Then, the samples of corneofix were analyzed using Visioscan VC98 and squamometry., Results: The parameter of TEWL and cohesion score show stable change trend. TEWL increased with frequency of stripping and were significantly higher compared with that of baseline on three sites. The results of staining of corneofix showed that the intercorneocyte cohesion is increased with the number of strips, and the more the number of strips, the more the fixation of dye per cell., Conclusion: The changes in the skin barrier function of different sites were different after it accepted physical stimulation, the process of damaging skin barrier could be divided into three stages based on the △TEWL. In addition, through stripping the skin of an adult, the in vivo model of damaged skin barrier could be setup., (© 2012 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.)

Background: Reliable securement of nasally inserted enteral tubes is a problem in patients with facial burns that make use of traditional adhesive tape ineffective., Objective: To implement the nasal bridle as a way to decrease inadvertent removal of nasally inserted enteral tubes and improve subsequent patient outcomes., Methods: The nasal bridle was implemented in the burn unit of the University of Kansas Hospital, Kansas City, Kansas, as a quality improvement project. Outcomes for the calendar year 2010 were measured in patients treated before use of the bridle (prebridle control group) and in patients for whom the bridle was used. The groups were compared on measures of tube insertions per tube day, abdominal radiographs per tube day, and a number of complications., Results: A total of 50 patients were studied: 33 in the control group and 17 in the bridle group. Baseline characteristics of age and sex did not differ between the groups. The bridle group had significantly fewer tube insertions and abdominal radiographs per tube day than the control group. Although complications were generally less common in the bridle group, the differences were not statistically significant., Conclusions: In burn patients, use of a nasal bridle to secure nasally inserted tubes had clinical advantages over securement with traditional adhesive tape.

Background: Despite the frequent use of porcine ear skin for tape-stripping experiments, the peculiarities of this skin type have not been characterised in detail yet. Thus, different techniques were employed to investigate the skin surface structure of porcine ear skin and the changes in barrier function during in vitro tape stripping. To this end, the potential of capacitance-based skin hydration imaging as a means of skin quality control was investigated for the first time., Methods: The porcine ear model was characterised before and during tape stripping using transepidermal water loss (TEWL) measurements, capacitance-based sensor imaging, attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR) and optical light microscopy., Results: The capacitance-based sensor was found to deliver precise information about the quality of the employed skin sites before and during tape stripping. The removal of stratum corneum proteins was highly reproducible even for different porcine ear types. The mean greyscale values showed an excellent linear correlation to the corresponding TEWL values and the respective penetration depth. Optical light microscopy confirmed the presence of canyons on the surface of porcine ear skin., Conclusion: The results suggest that the capacitance-based sensor is a suitable tool for skin integrity testing of porcine ear skin in vitro and for monitoring changes in skin barrier function., (© 2012 John Wiley & Sons A/S.)

Background: Many in vivo biophysical studies focus on parts of the body which are generally less exposed to the environment compared with facial skin. This study characterizes in vivo changes in the barrier function of cheek stratum corneum (SC) during controlled conditions of damage., Objectives: The objective was to investigate structural and compositional changes in cheek SC in vivo using tape stripping and Attenuated Total Reflectance Fourier Transform Infrared (ATR-FTIR) spectroscopy., Methods: In vivo ATR-FTIR spectra of the cheek were collected before and after tape stripping. Trans epidermal water loss (TEWL) measurements from the same site were conducted before and after stripping. Data were also collected 24 h after the last tape strip to investigate any initial recovery process., Results: Sequential tape stripping of the cheek progressively increases TEWL to twice baseline values but some barrier recovery is evident 24 h later. ATR-FTIR spectra show increasing water content within the SC with each tape strip with concomitant increase in lipid conformational order., Conclusions: Several structural and compositional parameters have been analyzed for cheek SC and these have been correlated with barrier function. The depth dependent changes in face SC map those in body skin but over a much shorter distance., (© 2012 John Wiley & Sons A/S.)

Background/aims: Few attempts have been made to distinguish the softness of different skin layers, though specific measurement of the superficial layer would be useful for evaluating the emollient effect of cosmetics and for diagnosis of skin diseases., Materials and Methods: We developed a sensor probe consisting of a piezoelectric tactile sensor and a load cell. To evaluate it, we firstly measured silicone rubber samples with different softness. Then, it was applied to human forearm skin before and after tape-stripping. A VapoMeter and skin-surface hygrometer were used to confirm removal of the stratum corneum. A Cutometer was used to obtain conventional softness data for comparison., Results and Conclusions: Both the piezoelectric tactile sensor and the load cell could measure the softness of silicone rubber samples, but the piezoelectric tactile sensor was more sensitive than the load cell when the reaction force of the measured sample was under 100 mN in response to a 2-mm indentation. For human skin in vivo, transepidermal water loss and skin conductance were significantly changed after tape-stripping, confirming removal of the stratum corneum. The piezoelectric tactile sensor detected a significant change after tape-stripping, whereas the load cell did not. Thus, the piezoelectric tactile sensor can detect changes of mechanical properties at the skin surface. The load cell data were in agreement with Cutometer measurements, which showed no change in representative skin elasticity parameters after tape-stripping. These results indicate that our sensor can simultaneously measure the mechanical properties of the superficial skin layer and whole skin., (© 2012 John Wiley & Sons A/S.)

Background: Chronic wounds require frequent dressing changes. Adhesive dressings used for this indication can be damaging to the stratum corneum, particularly in the elderly where the skin tends to be thinner. Understanding the level of damage caused by dressing removal can aid dressing selection., Methods: This study used a novel methodology that applied a stain to the skin and measured the intensity of that stain after repeated application and removal of a series of different adhesive types. Additionally, a traditional method of measuring skin barrier damage (transepidermal water loss) was also undertaken and compared with the staining methodology., Results: The staining methodology and measurement of transepidermal water loss differentiated the adhesive dressings, showing that silicone adhesives caused least trauma to the skin., Conclusion: The staining methodology was shown to be as effective as transepidermal water loss in detecting damage to the stratum corneum and was shown to detect disruption of the barrier earlier than the traditional technique., (© 2012 John Wiley & Sons A/S.)

Objective: Bladder injuries are quite rare and complex complications of transobturator tapes in the treatment of female stress urinary incontinence, with very few published cases. The authors present a case report and discuss possible injury mechanisms and the role of cystoscopy in this setting., Methods: A 51 year-old female with past surgical history of Burch colposuspension underwent an uneventful transobturator tape surgery. After 15 days, she complained of dysuria and frequency. Cystoscopy revealed the tape protruding within the bladder., Results: Reoperation was performed with the sub-urethral segment of the tape removed by vaginal approach and the vesical one excised endoscopically. Presently, the patient is asymptomatic., Conclusions: In patients with previous incontinence surgical treatments, cystoscopy at the time of surgery should be considered to exclude and treat eventual injuries, in order to avoid future complications.

Skin damage caused by a single specific stimulus has been extensively studied. However, many additional mild skin irritants are experienced every day before obvious irritant contact dermatitis (ICD) appears. The effect that these previously experienced mild irritations have on the incidence and severity of sequential ICD remains undefined. The purpose of this work was to explore whether the effects of skin barrier damage induced by either the open patch test with 1% sodium lauryl sulfate (SLS), tape stripping test (TAP) (10×), or irradiation with 0.75 median erythemal dose UVB (MED) will affect the severity of sequential irritant dermatitis induced by a 0.5% SLS occlusive patch test (PT). Nine treatments were applied to nine different locations of the ventral forearm of each subject at random. The nine treatment types were as follows: open patch test with 1% SLS; 10× TAP; UVB irradiation with 0.75 MED; open patch test with 1% SLS + PT with 0.5% SLS (SLSPT); 10× TAP + PT with 0.5% SLS (TAPPT); UVB irradiation with 0.75 MED + PT with 0.5% SLS (UVPT); PT with distilled water (DISPT); PT with 0.5% SLS (PT); and the CONTROL (no treatment). After 5 days of subclinical irritation, the PT was applied on day 6. Transepidermal water loss (TEWL), capacitance (CAP), and skin color (a*) were measured at baseline and on days 6, 7, and 8. After the PT, indices of irritancy of PT, UVPT, SLSPT, and TAPPT were 60, 80, 87 and 100%, respectively. The index of irritancy of TAPPT and SLSPT were significantly higher than that of PT (p < 0.05). Clinical scores of SLSPT and TAPPT were also significantly higher than PT (p < 0.05). After 5 days of irritation, TEWL of SLS, TAP, SLSPT, and TAPPT were increased significantly compared to that of baseline. After the PT, D-value of TEWL between day 8 and day 6 ((≥6-8)TEWL) of SLSPT and TAPPT were greater than that of PT, and D-value of TEWL between day 8 and day 7 ((≥7-8)TEWL) of SLSPT and TAPPT were less than that of PT values. After the PT, a* values of SLSPT, TAPPT and PT all increased. The D-value of a* between day 8 and day 6 ((≥6-8)a*) of SLSPT and TAPPT were significantly greater than that of PT. After the PT, D-value of CAP between day 8 and day 6 ((≥6-8)CAP) of SLSPT was significantly different as compared to PT. The open patch test with 1% SLS and 10× TAP destroys the skin barrier and is able to significantly increase the irritancy and severity of sequential ICD by 0.5% SLS PT, and therefore influences the recovery speed of inflammation. The open patch test with 1% SLS, 10× TAP, and UVB irradiation with 0.75 MED affects the skin barrier to different degrees. TEWL is a sensitive biophysical parameter that can reflect mild damage to the skin barrier induced by subclinical irritation.

Objective: To determine if solvent-assisted tape removal reduces pain when compared with dry tape removal., Method: A double-blinded comparative study was performed, in which commonly used solvents, namely water, alcohol, peanut oil, sunflower oil, and Leukotape remover (BSN medical), were applied to six zinc oxide adhesive tapes (Leukoplast, BSN medical), 10 cm long, 2.5 cm wide that had been placed on the volar side of each forearm of adult volunteers. One tape was left dry. Pain was measured using a visual analogue scale (VAS) and statistically analysed., Results: There were no statistically significant differences in VAS pain scores between the used substances when compared with the dry tape (p=0.39). The use of oil (peanut and sunflower) caused remains of adhesive to occur significantly more often (p<0.05)., Conclusion: Applying substances to ease pain associated with the removal of adhesive tapes does not lead to a reduction of pain when compared with dry tape., Conflict of Interest: None.

Background: Normally, percutaneous absorption tests are carried out using skin biopsies for an apparent and acceptable physiological condition. However, under different pathological conditions, the stratum corneum (SC) barrier function is impaired., Methods: The barrier function of the SC was assessed by correlation between the number of repeated applications of tape strips on the skin and its transepidermal water loss (TEWL), as well as by in vitro percutaneous absorption studies of different compounds, using Franz diffusion cells and porcine skin previously stripped., Results: A progressive diminution of the skin barrier function has been detected by TEWL both in vitro and in vivo as the number of skin tape strips increases. On the other hand, the percutaneous absorption of the compounds tested increases in a different way as the number of strips increases. Salicylic acid increases linearly depending on the barrier disturbance. However, percutaneous absorption of caffeine exponentially increased with barrier disturbance. Our results indicate that the barrier impairment of skin always increases the penetration behavior of a given compound; however, the hydrophilic-lipophilic balance of the compounds or formulations used could greatly modify its penetration profile, especially when a modified skin is used., Conclusions: This in vitro protocol may be useful to simulate the percutaneous absorption profile of some drugs applied onto skin with an impaired SC barrier function and could be used to avoid, to some extent, the use of in vivo experimental animal models in the dermopharmaceutical field., (© 2011 The International Society of Dermatology.)

Background: Multiple options are available for closure of hysterectomy incisions. This study compared postoperative clinical and economic outcomes using topical skin adhesive (2-octyl cyanoacrylate; OCA) vs. conventional skin closure in women undergoing total abdominal hysterectomy., Methods: A multi-hospital administrative database was used to identify women discharged in 2005 who had undergone total abdominal hysterectomy. Patients, classified by skin closure as suture (n = 21,201), staples (n = 23,441), OCA (n = 880), or staples + OCA (n = 489), were compared on length of inpatient stay (LOS), total inpatient cost, and non-prophylactic antibiotic treatment after day four., Results: The unadjusted mean LOS was 3.9, 4.5, 3.7, and 5.2 days for suture, staples, OCA, and staples + OCA, respectively; and the percentages of patients having antibiotic treatment were 12.93, 17.51, 11.14, and 23.72. There were overall differences in adjusted mean LOS, mean total cost, and antibiotic treatment (p < 0.0001). Pairwise comparisons indicated no difference between sutures and OCA, whereas the outcomes for each of the non-staple groups were more favorable than those for the staple group (p < 0.01). Results were similar in adjusted comparisons, with pairwise comparisons between OCA and staples at or near the threshold for significance., Conclusions: 2-octyl cyanoacrylate appears to be a safe and cost-effective alternative to topical sutures for patients having total abdominal hysterectomy. There were less favorable outcomes in groups receiving staples.

Several methods have been used in wound closure after coronary artery bypass grafting (CABG). In this study, the safety and efficacy of one of these methods, Steri-Strip S is compared with the traditional intracuticular suture method. Eighty-one patients undergoing CABG were prospectively randomized into two groups according to the method of skin closure: Steri-Strip S group and traditional suture group. Comparison between the two methods was done with regards to the length of the wound and the time needed to close it. The median closure time with Steri-Strip S was 5.45+/-3.35 min vs. 7.53+/-3.41 min in the suture group. A pain score of >or=6 at the first postoperative day was found in 30% of the patients in the suture group vs. 14% of the patients in the Steri-Strip S group (P=0.07). Cosmetic evaluation showed a non-significant difference in the linear visual analogue score in favor of Steri-Strip S group compared to the intracuticular suture group (73.1 vs. 70.1) (P=0.07). Steri-Strip S is a fast, safe alternative for wound closure of the sternotomy incision and graft harvesting site. A larger study is needed to establish the potential beneficial effect of Steri-Strip S on wound infection prevention.

Trauma to the skin from repeated removal of adhesive-based medical products can cause pain, anxiety, risk of secondary infections and additional health care costs. Skin barrier formulations are used to protect the integrity from such trauma. However, not all formulations are equally protective. We report the results of a randomised controlled study comparing a solvent-free (SF) formulation and a solvent-containing (SC) formulation to the skin of 12 healthy volunteers aged 18-55 years. Treatments were applied at baseline to two of the four test sites on the back of each subject and repeated for 5 days. Measurements of pain, discomfort, erythema and skin water loss were taken 24 hours after each application. The SF formulation is associated with lower mean scores for erythema (day 5, P < 0.05) and lower values for transepidermal water loss (day 5, P < 0.05) and redness (days 4 and 5, P < 0.05) when compared with either no treatment or daily treatment with a SC formulation. There were no significant differences between subject responses when pain on application of the test formulation or discomfort associated with removal of the medical adhesive tapes were rated. We conclude that a SF formulation provides better security against adhesive-derived skin trauma than a SC formulation.