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In hair- less mice discount 60 mg pyridostigmine fast delivery muscle relaxant jaw clenching, vitamin C levels are only slightly higher in the epidermis than in the dermis (5 buy pyridostigmine 60 mg low price back spasms 40 weeks pregnant,17) order pyridostigmine 60mg line muscle relaxant cvs. In human skin discount pyridostigmine 60 mg online muscle relaxant patch, which is dependent on dietary vitamin C, the epi- dermis apparently contains approximately fivefold higher levels than the dermis (18). This difference in dermal and epidermal vitamin C levels may reflect an increased utilization in the dermis for the regulation of collagen and elastin bio- synthesis (19), or facilitated transport mechanisms for vitamin C from the dermal Antioxidant Defense Systems in Skin 149 Table 1 Physiological Levels of Ascorbate in Cutaneous Tissues Skin layer Species Concentration References Year Total skin Rat 0. The epidermis is not only more directly exposed to the environment than the underlying dermis and therefore might have a higher demand of antioxidant protection, but also requires the presence of ascorbate for efficient formation of the stratum corneum barrier (20). Isolated human stratum corneum was reported to contain only very low ascorbate levels, as compared with levels in subjacent epidermal layers (6). The latter phenomenon is most likely due to both the hydrophobicity and, due to its location, the high degree of environmental exposure of the stratum corneum. In cells, glutathione is syn- thesized from glutamate, cysteine, and glycine (22). It acts as a substrate for numerous reducing enzymes, among them glutathione peroxidase and the phos- pholipid hydroperoxide glutathione peroxidase. Therefore, the absence of gluta- thione may lead to an accumulation of lipid hydroperoxides (2). In humans, who are dependent on dietary vitamin C intake, this link remains to be clarified. However, comparing the relative levels, most studies demonstrated higher glutathione levels in the epidermis than in the dermis. Since the epidermis is more directly exposed to the environment, it seems also possible that the pathways leading to the endog- enous formation of epidermal glutathione are upregulated by chronic environ- mental factors, as was shown for glutathione peroxidase in ozone-exposed lung epithelium (26). Urate Antioxidant Properties Uric acid (deprotonated form: urate) is a small water-soluble molecule (Fig. In blood plasma, urate has been shown to be a powerful scavenger of singlet oxygen, peroxyl-, and hydroxyl radicals (28). Fur- ther studies have demonstrated that urate scavenges ozone (15) and hypochlorous acid (29). In addition to its radical-scavenging potential, urate was proposed to stabilize reduced vitamin C in serum. This stabilizing effect appears to be due to inhibition of iron-catalyzed oxidation of ascorbate, which largely results from the formation of a stable, noncatalytic urate–iron complex (30). Unlike radical- scavenging reactions, this protective effect provided by iron chelation is not asso- ciated with depletion of urate. Direct free-radical attack upon urate generates allantoin, which has therefore been proposed as a marker molecule for free-radi- cal reactions in vivo (31). Prevalence in Skin Only little data are available on urate levels in cutane- ous tissues. Thus, as found for other antioxidants, the highest cutaneous urate levels are present in epidermal tissue. Lipid-Soluble Antioxidants Vitamin E Antioxidant Properties Vitamin E is the major lipophilic antioxidant in plasma, membranes, and tissues (33). The term ‘‘vitamin E’’ collectively refers to the eight naturally occurring molecules (four tocopherols and four tocotrie- nols), which exhibit vitamin E activity. Tocotrienols differ from tocopherols in that they have an isoprenoid instead of a phytyl side chain (see Fig. In humans, α– tocopherol is the most abundant vitamin E homologue, followed by γ–tocopherol. Vitamin E is among the early recognized biological antioxidants, and its redox and free-radical chemistry are well documented (33). The major antioxidant role of vitamin E is generally considered to be the arrest of chain propagation by scavenging lipid peroxyl radicals. The initial oxidation product of tocopherol is the metastable tocopheroxyl radical (Fig. Thus, one molecule of tocopherol is able to scav- enge two peroxyl radical molecules. Since the physiological molar ratio of to- copherols to polyunsaturated phospholipids, first-line targets of oxidative attack, is less than about 1:1000 in most biological membranes, regeneration of tocoph- erol is essential for its high antioxidant efficacy in vivo. As mentioned above, several hydrophilic coantioxidants, such as ascorbate and glutathione, can regen- erate vitamin E from the tocopheroxyl radical and thus enhance the antioxidant capacity of vitamin E (14). Furthermore, there is some in vitro evidence that ubiquinol-10 protects α– tocopherol from photo-oxidation by recycling mechanisms (37). In vitro, unphys- iologically high concentrations of α–tocopherol were reported to induce prooxi- dative effects leading to acceleration of lipid peroxidation (38,39). In human skin in vivo, however, such adverse health effects have not been reported. Prevalence in Skin As demonstrated in other body tissues, α-tocopherol is the predominant vitamin E homologue in murine and human skin (Table 3) (5,6,18). In addition, γ–tocopherol is present in murine and human epidermis, dermis, and stratum corneum. The α–tocopherol/γ–tocopherol molar ratio in the human dermis and epidermis is approx. Notably, a vitamin E gradient has recently been demonstrated in human upper arm stratum corneum. The highest α–tocopherol levels were found in the lower stratum corneum, whereas the low- est levels were present in the upper layers. The α–tocopherol/γ–tocopherol ratio Antioxidant Defense Systems in Skin 153 154 Thiele et al. The α–tocopherol levels in human dermis and epidermis were sever- alfold higher than in corresponding layers of hairless mouse skin (17,18). Consis- tently, human stratum corneum contains almost tenfold higher α–tocopherol lev- els than measured in murine stratum corneum (5,6). As observed for hydrophilic antioxidants, higher vitamin E levels were found in murine and human epidermis, as compared with dermal levels. It remains to be clarified whether the uptake and transport of α–tocopherol in the epidermis is an unspecific and passive process or, as described for human hepatocytes (33), is regulated by a mechanism involving a specific binding enzyme (α–tocopherol transfer protein). Ubiquinols/Ubiquinones (‘‘Coenzyme Q’’) Antioxidant Properties The terms ‘‘coenzyme Q,’’ as well as ‘‘ubiqui- none,’’ are commonly used for the redox couple ubiquinol/ubiquinone (see Fig. In nature, ubiquinone homologues containing 1 to 12 isoprene units occur; the predominant form of ubiquinone in humans is ubiquinone-10 (contains 10 isoprene units), and in mice ubiquinone-9. In liver cells, about 40 to 50% of the total cellular ubiquinone is located in the mitochondria, 25 to 30% in the nucleus, 15 to 20% in the endoplasmic reticulum, and only 5 to 10% in the cytosol (40). In vitro, the reduced forms of ubiquinones, the ubiquinols, are by two to three orders of magnitude more potent antioxidants (41). The role of ubiquinol/ubiqui- none as a redox carrier in the respiratory chain is well established, participating in the transfer of protons across the inner mitochondrial membrane (42). Ubiqui- nols can react with reactive oxygen species and thus prevent direct damage to biomolecules and initiation of lipid peroxidation. Although ubiquinones cannot prevent autocatalytic free-radical reactions by donating a phenolic hydrogen atom (unlike ubiquinols and tocopherols), it scavenges singlet oxygen and inhibits lipid peroxidation in model membranes (43). Furthermore, there is some in vitro evi- dence that ubiquinol-10 protects α–tocopherol against superoxide-driven oxida- tion (37).

Inversion therapy can offer quick cheap pyridostigmine 60mg line muscle relaxant vitamins, reliable pain relief as well as some long-term positive effects discount pyridostigmine 60 mg line muscle relaxant lodine. But everyone can benefit from inversion therapy buy pyridostigmine 60mg with visa spasms detoxification, because even if a person doesn’t have pain order pyridostigmine 60 mg on-line back spasms 34 weeks pregnant, the benefits are well worth the 3–5 minutes. We’ll discuss later under which circumstances and for how long you should use inversion therapy, but for now, let’s review how and why it works. As the name states, inversion therapy actually “inverts” the body to an upside-down position. There are several ways this can be performed, but the most common is by using what’s called an inversion table. Think of a seesaw with a bed on it—only the midpoint of the seesaw is much higher, so if you lean all the way forward you’re fully upright, and if you lean all the way back, you’re upside down. Since we live on Earth, we’re all subjected to the force of gravity on a day-to-day basis. Our muscles and bones help us stand up against it, but over the years, it tends to wear us down a bit—particularly the spine, which is the center of our upright posture. Spinal Compression The spine is made up of a series of bones called vertebrae that are stacked one on top of the other. In between these bones are doughnut-shaped discs—gel-like structures that are filled mostly with water and serve as the body’s shock absorbers. We’ve talked about how muscle imbalances can create postural dysfunctions that pressure the spine, in essence “squishing” the discs in uneven ways. A combination of tight and weak muscles can literally tilt the stack of vertebrae too far in any direction, greatly increasing the stress on one side of any particular disc. Imagine a balloon, for instance, one of those long ones that can be twisted into different shapes to make balloon animals. If you were to squish one side with your fist, all the air in the balloon would form a bulge at the other side. Keep pressing, 129 The 7-Day Back Pain Cure Inversion Therapy 130 What Is Inversion Therapy? As the name states, inversion therapy actually “inverts” the Discs operate much the same way. There are several ways this and gravity—apply uneven pressure on a disc, the disc bulges can be performed, but the most common is by using what’s to one side. The disc has actually developed a hernia, or bulge, at one An inversion table sits on a swivel and is made for you to end. Think of a seesaw with a bed on it—only the midpoint which is what many doctors believe causes the sharp, radiating of the seesaw is much higher, so if you lean all the way pain of this condition. Eventually, if the problem is not forward you’re fully upright, and if you lean all the way back, corrected, the disc can burst, losing its water content and its you’re upside down. The idea behind inversion therapy is to reverse the effects Even if we don’t have muscle imbalances adding to the of gravity. Since we live on Earth, we’re all subjected to the issue, which we all do, gravity by itself creates a daily force of gravity on a day-to-day basis. You may not realize this, but as help us stand up against it, but over the years, it tends to wear you go about your day, gravity presses down on your discs, us down a bit—particularly the spine, which is the center of causing the water inside them to slowly squeeze out. Measurements taken have shown that most people are slightly shorter at the end of the day than they were at the Spinal Compression beginning—by as much as three-quarters of an inch! Fortunately, the spinal discs reabsorb water while we sleep The spine is made up of a series of bones called vertebrae (as long as we’re not dehydrated), so we start the day again at that are stacked one on top of the other. However, over the years, our discs bones are doughnut-shaped discs—gel-like structures that are lose their ability to “re-inflate,” so we grow a little shorter by filled mostly with water and serve as the body’s shock the time we become seniors. A combination of tight and weak muscles can literally tilt the stack of vertebrae too Inversion therapy literally reverses the compression caused far in any direction, greatly increasing the stress on one side of by gravity—and in part, muscle imbalances. Instead of compressing your discs and can be twisted into different shapes to make balloon animals. Keep pressing, the muscles supporting the spine and torso, giving the discs 131 The 7-Day Back Pain Cure room to reabsorb fluids and move back into their proper positions—eliminating pressure on nearby nerves. You can find several videos about inversion therapy as well as a demonstration by going to: www. Even the slightest increase in spacing can create a mild suction, which can encourage a bulging disc to return to its normal position. If you picture again that balloon, it’s like taking your fist off one end and allowing the air inside to fill up the entire area once again. If a disc is pressing on a nerve, inversion therapy often will relieve that pressure, easing pain almost immediately. According to many clinical studies, inversion therapy is one of the most effective and fastest ways to increase space between your vertebrae. I’ve actually had clients tell me that their back pain, pain that had plagued them for decades, totally disappeared with just a few minutes of inversion therapy. Other cases completely reversed themselves with just a week of inversion therapy—10 minutes a day of hanging upside down. If you need to get back to work and you suspect a herniated disc could be the source of your pain, inversion therapy may be the best way to recover. You can find several videos about inversion therapy as well as a demonstration by going to: Many More Benefits www. Turning the body upside down, for With the increased spaces between the vertebrae that your blood, is like taking a road that normally climbs uphill and making it go downhill. In other words, where the blood inversion therapy creates, discs are suddenly relieved of usually had to travel up, it now heads down, and vice versa. Even the slightest increase in spacing can create a mild suction, which Suddenly it’s easier for the blood to get to certain areas that are usually a challenge to reach—particularly the upper back, can encourage a bulging disc to return to its normal position. This makes it easier for some of the muscles In essence, space gives the disc the room it needs to heal. If you picture again that balloon, it’s like taking your fist and joints to have easier access to the nutrients and oxygen they need. Pitch yourself pressing on a nerve, inversion therapy often will relieve that upside down for even a moment and you’ll feel some of the pressure, easing pain almost immediately. According to many clinical studies, inversion therapy is muscles in your back, legs, and hips pulling toward the ground, which has a stretching effect. Since these muscles are one of the most effective and fastest ways to increase space usually pulled in the opposite direction by gravity, inversion between your vertebrae. I’ve actually had clients tell me that their back pain, pain that had plagued them for decades, therapy helps counteract that effect, pulling them in the other direction and increasing flexibility. Other cases completely reversed themselves with just a instantly, knee, hip, ankle, and other joints experience a gentle “opening. If you need to get back to work and you suspect a herniated disc could be the source of your pain, inversion same to weight-bearing joints that are typically loaded all the time, every day. With the absence of pressure, the joints get therapy may be the best way to recover. Though inversion therapy will not correct muscle imbalances, it may help a crooked spine to realign itself.

Drug U must be an alpha-activator with no beta actions-the only choice is phenylephrine 60mg pyridostigmine overnight delivery muscle spasms youtube. Figure 11-4-4: The effects of Drug S are changed by treatment with the beta-blocker purchase pyridostigmine 60mg otc spasms face, but not by the alpha blocker (choices A order pyridostigmine 60mg with visa muscle relaxant vs analgesic, B purchase 60 mg pyridostigmine visa muscle relaxant kidney stones, and C are ruled out). Note that option A would have been a possibility but one would have to assume a low-dose of epinephrine. Figure 11-4-5: The effects of Drug H are changed by treatment with either an alpha- or beta- blocker, so Drug H must have activity at both receptors (choices C, D, and E are ruled out). Figure 11-4-6: Mecamylamine blocked reflexed tachycardia induced by Drug X, which dropped blood pressure by vasodilation. Note that the alpha agonist does not antagonize the decrease in respiratory resistance (a ~2 response). Because Drug X abolishes only the reflex tachycardia, it must be the ganglion blocker hexame- thonium (choice A). Arterial con- traction due to the alpha agonist (choice E) is reversed by the alpha-blocker (choice C). Arteriolar relaxation and tachycardia due to epinephrine (choice B) is reversed by the beta-blocker (choice D). Figure 11-4-10: Classic example showing that denervated tissues do not respond to indirect- acting agonists. In this case, tyramine fails to cause mydriasis in the left eye, but this eye is more responsive than the right eye to epinephrine (denervation supersensitivity). Tachycardia due to Drug R is unaffected by any antagonist, indicative of a beta activator (choice D). Rate of depolarization depends on number of Na" channels open, which in turn depends on resting membrane potential of the cell. In some His-Purkinje cells, transient outward K+ currents and inward cr currents contribute to the "notch" and overshoot. Phase 3 • Repolarization phase in which the delayed rectifier K+ current rapidly increases as the Caz+ current dies out because of time-dependent channel inactivation. Note that during phases 0 through 3 a slow Na" current ("window current") occurs, which can help prolong the duration of the action potential. Conductance Rate of spread of an impulse, or conduction velocity-three major determinants: Rate of phase 0 depolarization-as Vmax decreases, conduction velocity decreases and vice versa. Fundamental Concepts No appreciable Na+ current during phase 0 in these cells because the Na channels are either absent or in an inactive form because of the existing voltage. During repolarization, the Ca2+ currents are opposed and overcome by the delayed rectifier K+ current. The relative magnitudes of these opposing currents determine the "shape" of the action potential. Automaticity The ability to depolarize spontaneously confers automaticity on a tissue. Refractoriness • The inability to respond to a stimulus-property of all cardiac cells. Inactivation of the h gate is slower; therefore, it stays open longer and the Na channel is active. Rate of recovery is slower in ischemic tissue because cells may be partly depolarized at rest. This reduces the number of channels able to participate in the next depolariza- tion, which leads to a decrease in conduction rate in ischemic tissue. Chapter Summary The sequences of ionic events in the action potential of cardiac cells are described. Responsivity, capacity of a cell for depolarization, depends on resting membrane potential; con- ductance is the rate of potential spread; refractoriness is the inability to respond to excitation. Three conformations exist-resting (ready), active (open), and inactive (refractory). Class I drugs are least active when Na" channels are in the resting state (state-dependent actions). This results in an increased threshold for excitation and less excitability of hypoxic heart muscle. The uses for lidocaine, mexiletine, and tocainide are discussed, as are the metabolism and adverse effects of lidocaine. However, homeostatic mechanisms may lead to compensatory increases in heart rate and/or salt and water retention. The metabolic characteristics, clinical uses, and potential adverse effects of sympathoplegic drugs, which decrease peripheral resistance by decreasing sympathetic tone, are discussed. Sympathoplegic drugs also may act directly as adrenergic neuron blockers, alpha blockers, or beta blockers. Direct-acting vasodilators lower the peripheral vascular resistance mainly by causing arteriolar dilation. Figure 111-3-2illustrates the angiotensin system and the pharmacologic effects of these drugs. Digoxin has potential toxic effects that are in part dependent upon the electrolyte balance. Bipyridines, sympathomimetics, diuretics, beta blockers, and nesiritide also have uses in treating heart failure. Beta blockers act directly on the heart by decreasing the heart rate, the force of contraction, and cardiac output, thereby decreasing the work performed. Actions of Diuretics at the Various Renal Tubular Segments Hypokalemia and Alkalosis Diuretics that block Na+ reabsorption at segments above the collecting ducts will increase sodium load to the collecting tubules and ducts ("downstream"). This results in increased loss of K+ ~ hypokalemia, and in the case of both loop and thiazide diuretics the associated loss of H+ results in alkalosis. Actions of Potassium-Sparing Agents on Collecting Tubules • Drugs: Note - Spironolactone: aldosterone-receptor antagonist Eplerenone is a selective o Uses: aldosterone receptor blocker Hyperaldosteronic state devoid of antiandrogenic Adjunct to K+-wasting diuretics effect. In addition to their diuretic action, the loop and thiazide diuretics also cause vasodilation. Figure 111-6-1illustrates the water and ion exchange occurring in the various segments of a renal tubule and the site of action of the different classes of diuretics. The mechanisms causing their diuretic actions (Figure 111-6-3)and their clinical uses and adverse effects are discussed. The mechanisms leading to their diuretic actions (Figure 111-6-4)and their clinical uses and adverse effects are discussed. Spironolactone, amiloride, and triamterene are K+-sparing, weak diuretics that act at the collecting tubule and duct level. The mechanisms leading to their diuretic actions (Figure 111-6-5)and their clinical uses and adverse effects are discussed. Table 111-6-1summarizes the mechanisms of action, the urinary electrolyte patterns, and the resultant blood pH associated with administration of the various classes of diuretics. Chapter Summary An aberrant serum lipid profile is associated with increased risk of artherosclerosis and cardiac heart disease. Following a myocardial infarct, a 40-year-old male patient is being treated with a drug that affords prophylaxis against cardiac arrhythmias. Which one of the following drugs is associated with the development of a lupus-like syn- drome, especially in patients identified as "slow acetylators"?

Photoprotective effect of vitamins A and E on polyamine and oxygenated free radical metabolism in hairless mouse epidermis generic 60 mg pyridostigmine muscle relaxant drugs methocarbamol. Topical vitamin E inhibition of immunosuppression and tumorigenesis induced by ultraviolet radiation pyridostigmine 60 mg online muscle relaxant juice. Protective effect of a topically applied anti- oxidant plus an anti-inflammatory agent against ultraviolet radiation-induced chronic skin damage in the hairless mouse best 60 mg pyridostigmine muscle relaxant liver disease. The hairless mouse as a model of skin photoaging: its use to evaluate photoprotective materials cheap pyridostigmine 60mg without a prescription muscle relaxer 86 62. Photoprotective effect of superoxide-scav- enging antioxidants against ultraviolet radiation-induced chronic skin damage in the hairless mouse. The influence of topical and systemic vitamin E on ultraviolet light-induced skin damage in hairless mice. Reduction of sunburn damage to skin by topical application of vitamin E acetate following exposure to ultraviolet B radia- tion: effect of delaying application or of reducing concentration of vitamin E acetate applied. Importance of the form of topical vitamin E for prevention of photocarcinogenesis. Uptake and bioconversion of α-tocopheryl acetate to α-tocopherol in skin of hairless mice. Topical application and uptake of vitamin E acetate by the skin conversion to free vitamin E. Disposition and metabolism of topically administered α-tocopherol acetate: A common ingredient of commercially avail- able sunscreens and cosmetics. Vitamin E supplementation and in vivo immune response in healthy elderly subjects: A randomized controlled trial. Topical vitamin C protects porcine skin from ultraviolet radiation-induced damage. Protection against ultraviolet B radiation-induced photocarcinogenesis in hairless mice by green tea polyphenols. Inhibition of ultraviolet-induced formation of reactive oxygen species, lipid peroxidation, erythema and skin photosensitization by Poly- podium leucotomos. Topical or oral administration with an extract of Polypodium leucotomos prevents acute sunburn and psoralen-induced phototoxic reactions as well as depletion of Langerhans cells. Prevention of photocarcinogenesis by topical administration of pure epigallocatechin gallate isolated from green tea. Protective effects of silymarin Antioxidant Defense Systems in Skin 185 against photocarcinogenesis in a mouse model. Protection against ultraviolet-B radiation-induced local and systemic suppression of contact hypersensitivity and edema responses in C3H/HeN mice by green tea polyphenols. The antioxidant action of N-acetylcys- teine: its reaction with hydrogen peroxide, hydroxyl radical, superoxide, and hypo- chlorous acid. Antioxidant inhibition of skin inflammation induced by reac- tive oxidants: Evaluation of the redox couple dihydrolipoate-lipoate. Kinetic study of cutaneous and subcutaneous distribution following topical application of [7,8-14C]rac-α-lipoic acid onto hairless mice. Melatonin effect on arachidonic acid metabolism to cyclooxygenase derivatives in human platelets. Melatonin, 5-methoxytryp- tamine and some of their analogs as cyclooxygenase inhibitors in rat medial basal hypothalamus. Studies on the nature of in vitro and in vivo photosensitiza- tion reactions by psoralens and porphyrins. Epidermal localization and protective effects of topically applied superoxide dismutase. Photoprotective effect of topically applied superoxide dismutase on sunburn reaction in comparison with sunscreen. Effects of topically¨ ¨ applied antioxidants in experimentally provoked polymorphous light eruption. Chronic ultraviolet radiation-induced in- crease in skin iron and the photoprotective effect of topically applied iron chelators. Evaluation of a topical iron chelator in ani- mals and in human beings: short-term photoprotection by 2-furildioxime. Synergistic topical photoprotection by a combination of the iron chelator 2-furildioxime and sunscreen. The effects of topi- cal and oral l-selenomethionine on pigmentation and skin cancer induced by ultra- violet irradiation. The effect of topical l-selenomethionine on minimal erythema dose of ultraviolet irradiation in humans. Involvement of singlet oxygen in ultraviolet A-induced lipid peroxidation in cultured human skin fibro- blasts. Protective effect of topically applied conjugated hexadienes against ultraviolet radiation-induced chronic skin damage in the hairless mouse. Due to their composition, a barrier is built up that cannot 189 190 Wigger-Alberti and Elsner be penetrated easily. In addition, lipophilic ointments should have benefit against hydrophilic irritants and lipophobic ointments against hydrophobic irritants. Wa- ter-in-oil emulsions are recommended against water-soluble irritants such as de- tergents, acids, alkalics, metal-working fluids, and even plain water. On the other hand, oil-in-water emulsions are offered against lipophilic irritants such as oils, varnishes, and organic solvents. Special investigations have been undertaken to develop preparations with a dual mode of action, combining the different effects of hydrophilic and hy- drophobic ingredients or developing foamy skin protectors containing stearic acid, propylene glycol, glycerol, sorbitol, and dimethylpolysiloxane. Other preparations include a fatty amine amide acetate that binds to negatively charged carboxyl groups of keratin and the positive fatty ammonium ion of these substances binds firmly to the negative charge of the epidermis. This is supposed to build up a firm second layer on the skin, which prevents penetration of various agents in a steric manner (3). Protective Creams with Special Ingredients Some ingredients purportedly have special protective properties such as natural or synthetic tannery substances, zinc oxide, talcum, chelating agents, or other substances that can bind metal ions or reduce penetration through the skin. Tannin is used as a skin astringent in order to increase the mechanical resistance of the skin surface against microtraumas. Additionally, tannery agents cause a local decrease of perspiration, which seems to be helpful while wearing gloves (4). The decrease of swelling is caused by direct binding of the tanning substance to keratin. It is in the employers’ interest that this invest- Protective Creams 191 ment is not based on unfounded claims, but on scientific data. In recent years, noninvasive biophysical measurements have achieved great importance especially for clinically weak reactions.

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