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THE SKIN HEALTH and HYGIENE BENEFITS of ABSORBENT HYGIENE PRODUCTS and WIPES July 2008 Contents

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THE SKIN HEALTH and HYGIENE BENEFITS of ABSORBENT HYGIENE PRODUCTS and WIPES July 2008 Contents Summary Report - Sustainability Panel Discussion: THE SKIN HEALTH AND HYGIENE BENEFITS OF ABSORBENT HYGIENE PRODUCTS AND WIPES July 2008 Contents 1 Setting the Context 2 2 Skin Health, Hygiene and Baby and Infant Diapering 3 3 Skin Health, Hygiene and Incontinence Products 6 4 Skin Health, Hygiene and External Feminine Care Products 9 5 Skin Health, Hygiene and Wet Wipes 10 6 Product Safety Considerations 12 7 General Quality of Life Considerations for Absorbent Hygiene Product and Wipes 14 8 Areas for Future 16 9 Summary 18 From left to Right: Front: Diana Heelis, Carlo Gelmetti, Mandy Fader, Colin Michie and Bo Runeman. Back: Ralf Adam, Jan Faergemann, Pierre Conrath, Sarah Portway, Peter Elsner and Frank Akin. Foreword This report summarises proceedings and the Panel Participants: consensus viewpoint emanating from a panel of leading medical professionals who met Prof. Dr. Peter Elsner, collectively in Brussels during July 2008 to Klinik für Dermatologie und review the health, hygiene, safety and sus- dermatologische Allergologie tainability attributes of disposable absorbent Friedrich Schiller-Universität hygiene products. Germany The panel was comprised of eminent Dr Mandy Fader, dermatologists, paediatricians and inconti- Continence Technology and Skin Health nence health professionals from Germany, Group, School of Health Sciences The UK, Italy and Sweden. They discussed University of Southampton their own experience in medical practice and UK reviewed relevant scientific literature and research reports in order to reach consensus Prof Jan Faergemann, on the benefits and safety profile of absorbent Department of Dermatology hygiene products. Sahlgrenska University Hospital Sweden Industry is aware of occasional, but in its view, unwarranted criticisms reported in the Professor Carlo Gelmetti, news media and elsewhere about the utility and Department of Clinical Dermatology, societal benefits of absorbent hygiene products University of Milan & Head of the Paediatric such as baby diapers, adult incontinence Dermatology Services Maggiore General articles, feminine hygiene pads and wet wipes. Hospital of Milan This panel discussion enabled industry to hear the views of independent and eminent experts Dr Colin Michie, from the medical professions on these sub- Senior consultant lecturer in Paediatrics jects as evidenced from their own clinical and Ealing NHS Trust research experience. The panel meeting was UK hosted by EDANA, the voice of the nonwovens and related industries in Europe, under its Right for Hygiene Programme. (See Appendix One for the full list of participants.) Quality of Life and Disposable Absorbent Hygiene 1 1 Setting the Context The health benefits between the use of absorbent hygiene products and of disposable baby diapers and wipes skin health and general hygiene. EDANA member companies are confident that their Over the past 50 years absorbent hygiene products products provide skin health and hygiene benefits. such as baby diapers, incontinence products, femi- The industry association wanted however to hear nine protection pads and personal care wipes have the views of independent medical professionals to all become essential features of modern day life. gain their insights into these topics. Five individu- als, recognised globally for their specialist expertise Through innovation and improved technology their in dermatology, paediatrics and nursing care in five design, composition and performance have improved member states came together moderated by an dramatically from their early forms. In fact these external consultant to: products are so pervasive and so much part of every day life that they are now taken for granted by • Present their views on the current body of millions of people throughout the world. As their knowledge about the relationship between skin use has grown so too have there been dramatic health and hygiene and the use of modern day improvements in skin health; particularly in the absorbent hygiene products and personal wet incidence of diaper dermatitis. wipes; • Provide insights into this subject drawn from On occasion however absorbent hygiene products their own research and/or clinical experience; have erroneously been linked to health problems and • Discuss ideas for additional research that could their safety has been questioned. For the indus- be carried out to extend the current body of try, any suggestion that its products could have a knowledge about skin health, hygiene and the detrimental impact on health or hygiene is taken use of absorbent hygiene products and wet very seriously indeed, not least because the health wipes; and hygiene profile of these products is fundamental • Comment generally on the overall impact of to both their purpose and their acceptability within absorbent hygiene products and wet wipes on the society. The industry is unconditionally committed quality of life of both their users and the carers of to maintaining the highest standards in its product their users in today’s society. stewardship. It invests heavily in assuring the safety of its products and in researching the linkages What follows is a summary of the discussion which covered the full range of externally worn absorbent hygiene products and personal care wipes. EDANA is delighted that five such highly respected individuals in their fields share our belief in the importance of documenting the facts about the relationship between the use of absorbent hygiene products and skin health and hygiene. We are reassured by their overall endorsement of the benefits of absorbent hygiene products for skin health and hygiene and grateful for their use- ful suggestions for additional research, product improvements and new product design considera- tions. 2 Skin Health and Hygiene Benefits of Absorbent Hygiene Products and Wipes 2 Skin Health, Hygiene and Baby and Infant Diapering One of the most widely known skin conditions for Dr Colin Michie, Senior Consultant Lecturer babies and infants in the past has been diaper in Paediatrics, Ealing NHS Trust, UK. dermatitis. This is an irritant contact dermatitis ‘Severe diaper dermatitis is in which a combination of factors can compro- so unusual to see these days; mise the skin. Increased wetness, the mixing of when it does present paedia- faeces and urine and a higher skin pH can result tricians can find themselves considering in their initial in activation of faecal enzymes and the presence assessment whether it could of Candida albicans can lead to severe diaper rash potentially be an indicator of episodes. lack of care.’ Based on their own clinical experience and the Panellists summarised the main factors which published scientific research (see Appendix Two), the contribute to the few cases of diaper dermatitis that panel of experts agreed that the incidence of diaper present for treatment today as: dermatitis in babies and infants has decreased sub- stantially over the past 20 years. They noted also that • The use of low quality diapers – particularly in over that period of time knowledge within the medical poorer communities where cheaper diapering profession about the causes of diaper dermatitis and products are often imported and sold at local retail how to treat it has significantly improved as well. outlets; • Exuberant cleansing can irritate skin and impair its The primary reason for the dramatic reduction in the barrier properties; incidence of serious cases of diaper dermatitis which • The use of cloth diapers which are less effective in require medical intervention has been the wide- absorbing and retaining liquid; spread use of modern disposable diapers which offer • Poor hygiene practices and/or in the worst case superior absorbency and containment and therefore scenario, neglect in cleaning the diapered skin increased skin dryness. area during diaper changes; • An indicator of other illnesses such as a Professor Carlo Gelmetti, Department of Clinical gastrointestinal infection; Dermatology, University of Milan, Italy. • Inappropriate or poor fit of the diapers being used. ‘Things have changed a lot An infrequent type of dermatitis occurring on one since the 1980s when more or both hip areas has been reported. The very limited than 20 percent of the babies I literature1 published on this form of dermatitis treated presented with diaper suggested that it could have been caused either by dermatitis and some of those allergens in the anti-leak components of older diapers cases were very severe. At components, or because the reduced size and tighter that time, the use of old style pant-like fit of diapers designed for toddlers caused cloth diapers and the overuse of rubbing. Panellists confirmed that this type of steroid based treatment creams dermatitis is very rare. worsened the problem.’ 1 Di Landro A, Greco V, Valsecchi R. ‘Lucky Luke’ contact dermatitis from diapers with negative patch tests. Contact Dermatitis. 2002 Panel members confirmed that in the countries Jan;46(1):48-9. where they practice, they now see very few cases of Belhadjali H, Giordano-Labadie F, Rance F, Bazex J. “Lucky Luke” contact dermatitis from diapers: a new allergen? Contact Dermatitis. severe diaper dermatitis. 2001 Apr;44(4):248. Roul S, Ducombs G, Leaute-Labreze C, Taïeb A. ‘Lucky Luke’ contact dermatitis due to rubber components of diapers. Contact Dermatitis. 1998 Jun;38(6):363-4. Skin Health and Hygiene Benefits of Absorbent Hygiene Products and Wipes 3 It was noted that the few cases of diaper dermatitis While diaper dermatitis has been the dominant
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