To estimate the clinical and cost-effectiveness of using a skin protectant (Cavilon No Sting Barrier Film [NSBF] or Cavilon Durable Barrier Cream [DBC]; 3M) compared with not using a skin protectant in the management of venous leg ulcers (VLUs), in the UK. Method: A decision model was constructed depicting the patient pathways and associated management of a cohort of patients with and without a Cavilon formulation, plus dressings and compression. The model was based on the case records of a cohort of matched patients from The Health Improvement Network (THIN) database, who were first diagnosed with a VLU between 1 Jan 2008 and 31 Dec 2009. The model estimated the costs and outcomes of patient management over 6 months and the cost-effectiveness of using a Cavilon formulation relative to not using a skin protectant. Results: Patients' mean age was 80.2 years and 61% were female. Sixty-five per cent (n=166) of Cavilon patients received NSBF, and 35% received DBC. Between 6% and 9% of VLUs were healed at 6 months and 53–66% became infected. Healing was affected by a patient's age (OR: 0.944 for each additional year), but not by gender, level of exudate or wound size. There was a significantly greater reduction in wound size among patients in the NSBF group than in the other two groups (p < 0.001). Additionally, there was no significant difference in the initial wound size of those VLUs that did and did not heal in the two Cavilon groups; however, initial size of the VLUs that healed in the control group was significantly smaller than those that did not (p<0.001). Resource use was similar between the three groups. Patients were predominantly managed by practice nurses, with a mean 37–38 nurse visits over the study period. Patients' dressings were changed, on average, every 4–5 days, with a mean of 3 dressings under a compression bandage. The total 6-monthly NHS cost of managing a VLU was ∼£2200. Practice nurse visits were the primary cost driver, accounting for up to 58% of the 6-monthly NHS cost, whereas dressings accounted for < 10% of the cost. Conclusion: Use of NSBF leads to significantly greater wound size reduction than that observed in the other two groups and may facilitate the healing of larger wounds without increasing costs. Hence, use of NSBF for peri-wound skin protection in patients with exuding VLUs is the preferred treatment strategy. / 3M Health Care, manufacturers of Cavillon NSBF and Cavillon DBC

Les neurotoxiques organophosphorés (NOP) sont extrêmement toxiques et peu volatils. Dans des conditions normales de température et de pression, ils peuvent pénétrer rapidement la peau sous forme liquide et exercer leurs effets délétères. En milieu civil ou militaire, leur utilisation potentielle est toujours redoutée. Le développement de dispositifs de protection cutanée vis-à-vis de ces agents est donc d’un intérêt majeur pour les armées et la sécurité civile. Dans ce contexte, les objectifs de ce travail ont été de formuler et évaluer la stabilité et l’efficacité de topiques protecteurs cutanés (TP) vis-à-vis des NOP. Le premier objectif a consisté à mettre au point des TP de compositions et de formes galéniques différentes (émulsions, gels) puis à valider leurs stabilités physicochimiques. Cent trente TP ont été formulés et 30 ont montré une stabilité physicochimique satisfaisante. Le second objectif a été d’évaluer l’efficacité des TP les plus prometteurs vis-à-vis des composés organophosphorés. Actuellement il n’existe pas de standardisation de ce type d’étude. Par conséquent, l’utilisation de plusieurs tests in vitro et in vivo (membranes biologiques ou synthétiques, NOP ou simili), dont la pertinence et la fiabilité ont été déterminées, nous a permis d’établir une logique de criblage pour l’évaluation de l’efficacité des TP. Parmi les 13 formulations testées, les résultats ont montré qu’un gel hydro-alcoolique apporte une protection cutanée significative et supérieure aux produits de référence testés vis-à-vis du VX, un NOP d’intérêt / Prevention of exposure to the neurotoxic organophosphorus compounds (OP) that are quickly absorbed in the skin is a major concern both for pesticide users and soldiers. Skin barrier creams are being developed to complement or replace uncomfortable chemical protective suits. The objectives of this work were to formulate and assess physicochemical stability and protective efficacy of topical skin protectant (TSP) against OP compounds. The first objective was to formulate several different TSP (emulsions, gel) and validate their physicochemical stability.The second objective was to determine the consistency of results from in vitro tests and the importance of the formulation composition in the skin protective efficacy. Quick evaluation of formulations efficacy mainly relies on in vitro tests which lead to consistent, complementary and relevant results. Our results indicated that the least effective formulations could be quickly identified by performing in vitro permeation tests with silicone membrane and by evaluating interfacial interactions between formulations and OP. We showed that a hydrogel containing specific hydrophilic polymers was by far the most effective of the formulations evaluated against VX, OP compounds, skin permeation in vitro

Les nanomatériaux représentent un créneau de recherche en plein essor dans de nombreuxdomaines. Leurs propriétés inédites leur confèrent de nombreux avantages mais soulèvent égalementdes interrogations quant à leur profil toxicologique. Parmi leurs applications possibles, lesnanomatériaux sont intégrés au sein de topiques protecteurs : dans le secteur militaire, afin de limiterla pénétration cutanée des agents chimiques de guerre et dans le secteur cosmétique, notammentdans les produits de protection solaire. Ce travail porte sur l'intérêt du dioxyde de cérium pur ou dopéau calcium dans ces deux applications. Dans un premier temps, les nanoparticules ont étésynthétisées par une méthode hydrothermale, assistée de la voie micro-ondes. La caractérisation pardifférentes méthodes a permis d'identifier la phase cristalline du CeO2 et a montré que lesnanoparticules présentaient une taille de 3 nm, pouvant être augmentée jusqu'à 95 nm en fonction dutraitement thermique appliqué. Par la suite, l'efficacité des nanoparticules seules puis incorporées ausein de topiques à effets barrières vis-à-vis de la pénétration du paraoxon, agent organophosphoré, aété testée. Une émulsion H/E constituée de 10 % de cérine a permis de réduire de façon significativela pénétration du toxique. Enfin, la photoprotection et la sécurité d'emploi du CeO2 ont été comparéesà celles des filtres solaires, et notamment à celles de l'oxyde de zinc (ZnO) fréquemment rencontrédans les produits de protection solaire. Le CeO2, en améliorant la protection dans le domaine des UVBet en ne présentant aucun effet antiprolifératif ou génotoxique sur une lignée cellulaire dekératinocytes humains, représente une alternative particulièrement intéressante au ZnO. / Nanomaterials represent a growing niche research in many fields. Their unusual properties provide many benefits, but also raise questions about their toxicological profile. Among their applications, nanomaterials are integrated into topical skin protectant: in the military sector, in order to reduce skin penetration of chemical warfare agents and in the cosmetics industry, especially in sunscreen products. This work focuses on the interest of pure or calcium doped cerium dioxide in these two applications. Initially, the nanoparticles were synthesized by a microwave-hydrothermal method. Characterization by different methods has identified the crystalline phase of CeO2 and has showed that the nanoparticles had a size of 3 nm, which could be increased up to 95 nm depending on the heat treatment applied. Thereafter, the effectiveness of nanoparticles alone and then incorporated in a topical barrier cream over the penetration of paraoxon, organophosphorus agent was tested. An O/W emulsion, consisting of 10 % ceria, has reduced significantly the penetration of the toxic. Finally, photoprotection and safety of CeO2 were compared with sunscreens, and in particular with zinc oxide (ZnO), frequently encountered in sunscreen products. CeO2, improving protection in the UVB range and showing no antiproliferative or genotoxic effect on human keratinocyte cell line, is a particularly attractive alternative to ZnO.