Hand Dermatitis Relief: Cotton Gloves vs Sympatex Liners

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Hand dermatitis, often linked to occupational exposure and wet work, can be prevented with watertight gloves.¹ While protective, these can also exacerbate the condition due to occlusion effects.² To mitigate this, textile glove liners, like cotton, are recommended to absorb moisture and reduce occlusion. Additionally, these liners can enhance the effectiveness of topical treatments and provide a barrier against scratching.³

Semipermeable membrane gloves (such as those made by Sympatex) offer an alternative by allowing moisture to escape rather than trapping it, potentially reducing occlusion effects and aiding skin barrier recovery.⁴ Despite their thinner design improving tactility, researchers noted there is limited research on their effectiveness compared to textile gloves.

During an earlier study, 199 patients with hand dermatoses tested cotton gloves (COT) and Sympatex-lined cotton gloves (SYM/COT) for 19 nights. Both types were well-tolerated, but the study had limitations.⁵ The following study, a controlled multicenter trial, aimed to further assess the tolerability and user acceptance of SYM/COT and COT by comparing them with no comfort gloves.⁶

Methods

The study, a controlled multicenter intervention, took place from January 2020 to September 2022. Conducted across 4 centers in Germany, the study involved recruiting participants at the start of a 3-week inpatient phase of a tertiary individual prevention program (TIP) for severe work-related skin diseases. Participants were divided into two intervention groups (COT or SYM/COT) and a control group (CON) based on a quasi-randomized scheme. Intervention groups wore different glove combinations (COT alone or layered SYM/COT gloves) during the inpatient phase and the subsequent 19 nights at home. Researchers stated controls, which were excluded from the previous study, did not wear gloves.

Dermatologists at the participating centers evaluated the severity of hand dermatoses using the Osnabrueck Hand Eczema Severity Index (OHSI) on days 2, 7, 14 and 21 of the inpatient phase of the TIP. The OHSI is based on the presence or absence of 6 clinical signs (erythema, scaling, papules, vesicles, infiltration, fissures) and the extent of the skin area of both hands affected by each sign.⁷ Patients were also asked to rate the severity of their dermatosis using a photographic guide.

Results

In a study involving 284 patients with inflammatory hand dermatoses, 282 participants (SYM/COT: 146; COT: 136) completed the trial. Of the 88 patients recruited for the CON group, 20.5% wore COT during the inpatient phase and were excluded from the main analyses. Participants were predominantly women, with an average age of 45-49 years, and the most common diagnosis was hand eczema (SYM/COT: n = 138/146, 94.5%; COT: n = 125/136, 91.9%; CON: n = 63/70, 90.0%).

Researchers found both intervention groups showed improvements in skin condition over time, with no significant differences in OHSI scores between SYM/COT and COT. Self-assessed severity of hand dermatoses also improved “significantly” in both intervention groups, with no major differences by the end of the outpatient phase.

Regarding quality of life, researchers stated both intervention groups showed substantial improvements in HRQoL scores over time. At baseline, patients in both groups had severely impaired HRQoL, but by the end of the inpatient phase, this had improved to a moderate impairment level. The CON group showed similar trends, with no significant differences between groups at the end of the study.

The study’s survey results indicated that self-reported glove usage and satisfaction were similar between SYM/COT and COT, though COT was rated higher for fit, comfort, and ease of use. Researchers found SYM/COT was rated better for tactile sensitivity and climate comfort. At the end of the study, most patients in the COT group expressed a preference for using COT again, compared to a smaller percentage in the SYM/COT group.

Conclusion

Overall, the study confirmed that both SYM/COT and COT were well-tolerated and effective, with no substantial differences in their impact on skin condition or HRQoL. In line with previous data, the study found that SYM/COT received better ratings regarding climate conditions and tactility while COT showed superiority in fit, wearing comfort, and practicality.⁵ Researchers suggested that future research should explore the economic and environmental implications of different comfort gloves, for which a study is already in preparation.

References

1. Bauer A, Geier J, Mahler V, Uter W. KontaktallergienbeiErwerbstätigen in Deutschland :Ergebnisse des IVDK-Netzwerkes 2003-2013 [Contact allergies in the German workforce : Data of the IVDK network from 2003-2013]. Hautarzt. 2015;66(9):652-664. doi:10.1007/s00105-015-3660-7
2. Tiedemann D, Clausen ML, John SM, et al. Effect of glove occlusion on the skin barrier. Contact Dermatitis. 2016;74(1):2-10. doi:10.1111/cod.12470
3. Kuwatsuka S, Kuwatsuka Y, Tomimura S, et al. Impact of daily wearing of fabric gloves on the management of hand eczema: A pilot study in health-care workers. J Dermatol. 2021;48(5):645-650. doi:10.1111/1346-8138.15848
4. Baack BR, Holguin TA, Holmes HS, et al. Use of a semipermeable glove during treatment of hand dermatitis. Cutis. 1996;58(6):423-424.
5. Heichel T, Sonsmann FK, John SM, et al. Effects and acceptance of semipermeable gloves compared to cotton gloves in patients with hand dermatoses: Results of a controlled intervention study. Contact Dermatitis. 2022;87(2):176-184. doi:10.1111/cod.14123
6. Heichel T, Kersten JF, Braumann A, et al. Evaluation of comfort gloves made of semipermeable and textile materials in patients with hand dermatoses: Results of a controlled multicenter intervention study (ProTection II). Contact Dermatitis. August 1, 2024. doi:10.1111/cod.14649
7. Skudlik C, Dulon M, Pohrt U, et al. Osnabrueck hand eczema severity index--a study of the interobserver reliability of a scoring system assessing skin diseases of the hands. Contact Dermatitis. 2006;55(1):42-47. doi:10.1111/j.0105-1873.2006.00871.x