AbstractThe use of skin barrier-enhancing topical medication is a favorable approach for the treatment of occupational hand dermatitis (OHD). Cocos nucifera or coconut oil is one of the best sources of lipid enriched with laurate acid, and glycerin is a well-known humectant that improves skin hydration.

摘要使用增强皮肤屏障的局部药物是治疗职业性手部皮炎（OHD）的有利方法。椰子油或椰子油是富含月桂酸的脂质的最佳来源之一，甘油是一种众所周知的保湿剂，可改善皮肤水合作用。

This study is aimed is to evaluate the effectiveness of C. nucifera and glycerin for secondary prevention of OHD among batik (Indonesian traditional fabric) workers. In a randomized, double-blind, crossover trial, the effect of glycerine–C. nucifera cream versus glycerin-only was considered with multiple afterwork applications of moisturizer over a 2-week period on batik workers with OHD.

本研究旨在评估C.nucifera和甘油对蜡染（印尼传统面料）工人OHD二级预防的有效性。在一项随机、双盲、交叉试验中，甘油-C的作用。。

Assessment of trans-epidermal water loss (TEWL), skin capacitance, and a clinical assessment using the Hand Eczema Severity Index (HECSI) were carried out at day 0 and 14. The results show thirty-two batik dyeing and/or rinsing workers were enrolled in the study with mild to moderate OHD. Clinical improvement was demonstrated by 20% decrease in HECSI and TEWL, and 20% increase in skin capacitance.

在第0天和第14天进行经表皮失水（TEWL），皮肤电容的评估以及使用手部湿疹严重程度指数（HECSI）的临床评估。结果显示，32名蜡染和/或漂洗工人参加了轻度至中度OHD的研究。临床改善表现为HECSI和TEWL降低20%，皮肤电容增加20%。

Both moisturizers were equally effective for the secondary prevention of OHD. As a conclusion, glycerine–C. nucifera and glycerin-only cream are equally effective for secondary prevention for OHD among batik worker to reduce the prevalence of hand dermatitis..

两种保湿剂对OHD的二级预防同样有效。总之，甘油-C。nucifera和纯甘油乳膏对蜡染工人的OHD二级预防同样有效，可降低手部皮炎的患病率。。

IntroductionBatik is well-known as an intangible cultural heritage in Indonesia, claimed by United Nations Educational, Scientific and Cultural Organization (UNESCO) in 20091. Batik is handwriting, a way of decorating by covering a part of the clothing with a coat of wax, followed by a dyeing process.

简介巴蒂克是印度尼西亚著名的非物质文化遗产，于20091年被联合国教育、科学及文化组织（UNESCO）申报。蜡染是一种笔迹装饰，用蜡覆盖一部分衣服，然后进行染色。

Batik has become more popular over the years due to the dynamic development in the technological, esthetical, functional, and economic aspects1. The process of batik manufacturing is similar in different areas, but each region has its own characteristic of pattern and colour. Batik processing requires some materials that act as irritants or allergens, which can cause occupational hand dermatitis (OHD)2.

多年来，由于技术，美学，功能和经济方面的动态发展，蜡染越来越受欢迎1。不同地区的蜡染制造工艺相似，但每个地区都有自己的图案和颜色特征。蜡染加工需要一些作为刺激物或过敏原的材料，这可能导致职业性手部皮炎（OHD）2。

The hazards exposure includes excessive water, caustic agents, detergents as irritants and synthetic dyes (naphtol) as allergens2.Physical personal protective equipment (PPE) was not standardised and often locally modified by the workers2. There are not many studies reported regarding the use of moisturizers specific to a particular job2.

暴露的危害包括过量的水，腐蚀剂，洗涤剂作为刺激物和合成染料（萘酚）作为过敏原2。物理个人防护设备（PPE）不标准，通常由工人进行局部修改2。。

The goal of treatment for hand dermatitis is to improve the skin barrier function with appropriate moisturizers3,4. Various studies have demonstrated that regular use of hand lotions or creams can increase skin hydration and treat allergic or irritant contact dermatitis5,6. Moisturizers have many effects on the skin7,8.

手部皮炎的治疗目标是用适当的保湿剂改善皮肤屏障功能3,4。各种研究表明，经常使用洗手液或面霜可以增加皮肤水合作用，治疗过敏性或刺激性接触性皮炎5,6。保湿霜对皮肤有很多影响7,8。

They may form a form of coating, which acts as a barrier for chemicals from the exterior and restricts the loss of water and other important substances from the interior. Moisturizers are used as an adjuvant besides physical PPE and its limitations4. Nevertheless, evidence supporting the superiority of moisturizers containing lipids over the more traditional moisturizers is still lacking2.Because OHD may be concerned, not m.

它们可以形成一种涂层形式，作为外部化学物质的屏障，并限制水和其他重要物质从内部流失。除了物理PPE及其限制外，保湿剂还用作佐剂4。然而，支持含有脂质的保湿剂优于更传统的保湿剂的证据仍然不足2。因为可能涉及OHD，而不是m。

Table 1 Sociodemographic characteristics of subjects (N = 32).Full size tableResultsThirty-two batik workers with hand dermatitis were enrolled in the study after informed consent was obtained (Table 1). The flow of subject enrolment is shown in Fig. 1. The patients were recruited from several traditional batik enterprises in Yogyakarta, Central Java, Indonesia.In the initial period, one subject did not come at the second visit, while at the second period, one subject did not come at both visits.

表1受试者的社会人口学特征（N=32）。全尺寸表结果在获得知情同意后，32名患有手部皮炎的蜡染工人参加了这项研究（表1）。。这些患者是从印度尼西亚中爪哇日惹的几家传统蜡染企业招募的。在最初的阶段，一名受试者在第二次访问时没有来，而在第二阶段，一名受试者在两次访问时都没有来。

Both subjects denied protocol or side effects of the study as the reason for absence. Before data analysis, data clearance was conducted, and 1,875% missing value was found. However, the data was still fit to be processed using SPSS 22, and the distribution test was done with the Shapiro–Wilk normality test.Clinical evaluationPrior to the study, clinical characteristics of 32 subjects based on location, type of dermatitis, and nail discolouration were observed.

两名受试者均否认该研究的方案或副作用是缺席的原因。在数据分析之前，进行了数据清理，发现1875%的缺失值。但是，数据仍然适合使用SPSS 22进行处理，并且分布检验是通过Shapiro–Wilk正态性检验完成的。临床评估在研究之前，观察了32名受试者基于位置，皮炎类型和指甲变色的临床特征。

The lesions occurred on the dorsum aspect of the hand of 2 subjects (6.3%), palmar of 17 subjects (53.1%), the finger of 10 subjects (31.3%), and ginger tips of 3 subjects (9.4%). For the types of hand dermatitis, there was no chronic hand eczema (0%), 2 subjects had recurrent vesicular hand eczema (6.3%), 18 subjects had hyperkeratotic palmar eczema (56.3%).

病变发生在2名受试者的手背（6.3%），17名受试者的手掌（53.1%），10名受试者的手指（31.3%）和3名受试者的姜尖（9.4%）。对于手部皮炎的类型，没有慢性手部湿疹（0%），2名受试者患有复发性水疱性手部湿疹（6.3%），18名受试者患有角化过度的手掌湿疹（56.3%）。

Three subjects had pulpitis (9.4%), and 5 subjects had interdigital eczema (15.6%), while 4 had nummular hand eczema (12.5%). In this study, the predominant location of hand dermatitis was the palmar aspect, with hyperkeratotic palmar eczema as the most prevalent type. Most subjects had nail discolouration (96.97%), while only one subject had no nail discolouration.

3名受试者患有牙髓炎（9.4%），5名受试者患有指间湿疹（15.6%），而4名受试者患有颈部手部湿疹（12.5%）。在这项研究中，手部皮炎的主要部位是手掌，角化过度的手掌湿疹是最常见的类型。大多数受试者指甲变色（96.97%），而只有一名受试者没有指甲变色。

The following table presents the baseline conditions of the subjects based on the treatment group (Ta.

下表列出了基于治疗组（Ta）的受试者的基线状况。

Table 2 HECSI, TEWL, and skin capasitance baseline against subject groups (mean (standard deviation)).Full size tableHand eczema severity indexHECSI score was determined (ranging 0–360) based on observation of morphological lesions. Common morphologies were erythema, infiltration, vesicles, fissures, squamous, and edema.

表2针对受试者组的HECSI，TEWL和皮肤容量基线（平均值（标准偏差））。根据形态学病变的观察，确定了全尺寸桌手湿疹严重程度指数（ECHSI）评分（范围为0-360）。常见的形态是红斑，浸润，囊泡，裂缝，鳞状和水肿。

During the first period, the lowest baseline HECSI score was 10, and the highest was 54. During the second period, the lowest baseline was 7 and the highest was 54. Compared to the baseline, both groups showed a decrease in the HECSI score. The change in median HECSI score after treatment between periods 1 and 2, in the A-B treatment sequence, was not statistically significant (p = 0.477).

在第一阶段，最低的基线HECSI评分为10分，最高的为54分。。与基线相比，两组的HECSI评分均下降。在A-B治疗序列中，第1和第2阶段治疗后HECSI评分中位数的变化无统计学意义（p=0.477）。

Likewise, the median change in the HECSI score after treatment in periods 1 and 2, in the B-A treatment sequence, was not statistically significant (p = 0.166) (Table 3) (Supplementary file 3). A positive change from baseline indicates a decrease in HECSI and, therefore, an improvement in the skin conditions.

同样，在B-A治疗序列中，第1期和第2期治疗后HECSI评分的中位数变化无统计学意义（p=0.166）（表3）（补充文件3）。与基线相比的积极变化表明HECSI降低，因此皮肤状况有所改善。

Both moisturizers showed a clinically significant treatment effect on HECSI from baseline to day 14..

从基线到第14天，两种保湿剂均显示出对HECSI的临床显着治疗效果。。

Table 3 HECSI score after treatment based on sequence group (median (IQR)).Full size tableEffect of treatment on trans-epidermal water lossThe mean value of TEWL for dorsum A-B, and B-A after receiving coconut oil and glycerine-only cream is presented in Fig. 2. In the AB period 1 sequence group, the first group to get coconut oil moisturizing cream, the final TEWL value was 29.6 (9.03) g/m2/h after application of product A, and 18.1 (4.71) g/m2/h after application of product B.

表3基于序列组的治疗后HECSI评分（中位数（IQR））。全尺寸表治疗对经表皮水的影响在接受椰子油和纯甘油乳膏后，背部A-B和B-A的TEWL平均值如图2所示。在AB期1序列组中，第一组获得椰子油保湿霜，使用产品A后最终TEWL值为29.6（9.03）g/m2/h，使用产品B后最终TEWL值为18.1（4.71）g/m2/h。

The inter-individual difference is 11.5 (9.45) g/m2/h. In the BA group, the mean final TEWL value of the hand dorsum was 18.8 (7.79) g/m2/h after application of product A and 25.9 (6.11) g/m2/h with inter-individual differences of − 7.1 (8.51) g/m2/h (Supplementary file 2).Fig. 2Comparison of mean Dorsum and Palmar TEWL values between periods 1 and 2 for each treatment sequence.Full size imageThe final skin capacitance value of the subject's hand in the AB treatment sequence group after the use of product A was 70.77 (28.01) AU, whereas for product B it was 60.52 (10.33) AU, with inter-individual differences of 10, 3 (27.39) AU.

个体间差异为11.5（9.45）g/m2/h。在BA组中，施用产品A后手背的平均最终TEWL值为18.8（7.79）g/m2/h，25.9（6.11）g/m2/h，个体间差异为-7.1（8.51）g/m2/h（补充文件2）。图2每个治疗序列在周期1和2之间的平均背部和手掌TEWL值的比较。全尺寸图像使用产品A后，AB治疗序列组受试者手的最终皮肤电容值为70.77（28.01）AU，而产品B为60.52（10.33）AU，个体间差异为10,3（27.39）AU。

Whereas in the B-A treatment sequence group, the final TEWL value on the dorsum of the subject's hand was 67.52 (16.47) AU after using product A, and 78.47 (26.39) AU after application of product B (Fig. 3).Fig. 3Comparison of mean dorsum and palmar SCap values between periods 1 and 2 for each treatment sequence.Full size imageBased on the difference in mean HECSI score, the TEWL value and skin capacitance of dorsum hand and palmar skin capacitance between before and after the treatment shown in Table 4, established a difference in batik workers who received coconut oil-glycerin moisturizing cream (product A) and glycerin only (product B).

而在B-A治疗序列组中，使用产品A后受试者手背的最终TEWL值为67.52（16.47）AU，使用产品B后为78.47（26.39）AU（图3）。图3每个治疗序列在周期1和2之间的平均背侧和掌侧肩胛值的比较。全尺寸图像根据表4所示治疗前后平均HECSI评分，TEWL值和手背皮肤电容以及手掌皮肤电容的差异，确定了接受椰子油甘油保湿霜（产品a）和仅甘油（产品B）的蜡染工人的差异。

It was determined that the diff.

确定差异。

Table 4 Relative differences of baseline score of HECSI, TEWL dan SCap between two groups.Full size tableOf the 32 subjects, no adverse effects were found due to the use of product A and glycerine-only cream. Among 32 subjects, there were 27 (84%) subjects who stated that they liked the distinctive smell of coconut oil in the test cream.

表4两组之间HECSI、TEWL和SCap基线评分的相对差异。全尺寸表在32名受试者中，由于使用产品A和纯甘油乳膏，未发现不良反应。在32名受试者中，有27名（84%）受试者表示他们喜欢测试奶油中椰子油的独特气味。

Both were given coconut oil aroma for blinding purposes. All subjects felt comfortable using the cream after bathing and do not feel the work is interrupted by the use of both test creams and stated the skin is softer after the use of both test creams.DiscussionThe effectiveness of moisturizers is determined by various components, including active ingredients, vehicle, penetration ability, ease of application, cosmetics acceptance, comfort, and minimal intersection effects17.

出于致盲目的，两者都被给予椰子油香气。所有受试者在沐浴后都觉得使用面霜很舒服，并且不觉得使用两种测试面霜会中断工作，并表示使用两种测试面霜后皮肤更柔软。讨论保湿剂的有效性取决于各种成分，包括活性成分，载体，渗透能力，易用性，化妆品接受度，舒适度和最小交叉效应17。

In making moisturizers specifically for occupational fields, it is also necessary to consider the reactions that can occur between the material found in moisturizers and exposure to the workplace environment18. The use of moisturizers is expected to not facilitate the penetration of irritant or allergen material, which exacerbates the occurrence of occupational dermatitis3.

在专门为职业领域制造保湿剂时，还需要考虑保湿剂中发现的物质与暴露于工作场所环境之间可能发生的反应18。预计使用保湿剂不会促进刺激性或过敏原物质的渗透，从而加剧职业性皮炎的发生3。

Moisturizing texture needs to be designed so that it does not interfere with work. Adherence to the use of moisturizers is very important to note, workers need to understand the importance of using moisturizers for prevention of dermatitis, as well as the correct use, both frequency and volume of moisturizers4,8.The lipid concentration used, the amount and type of emulsion, humectant, and preservative materials need to be considered, including the pH of the moisturizer3,8,15.

保湿质地的设计需要确保不会干扰工作。坚持使用保湿剂非常重要，需要注意的是，工人需要了解使用保湿剂预防皮炎的重要性，以及正确使用保湿剂的频率和体积4,8。需要考虑使用的脂质浓度，乳液，保湿剂和防腐剂的数量和类型，包括保湿剂的pH值3,8,15。

The active ingredients used in this study were 30% coconut oil and 20% glycerin, as well as the excipients that matched t.

本研究中使用的活性成分是30%椰子油和20%甘油，以及与t相匹配的赋形剂。

Data availability

数据可用性

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

。

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Download referencesFundingThis study was funded by the final assignment grant for doctoral students of Universitas Indonesia “Hibah TADOK Universitas Indonesia”.Author informationAuthors and AffiliationsDermato-venereology Department, Faculty of Medicine, Universitas Indonesia, Depok, IndonesiaWindy K.

。作者信息作者和附属机构印度尼西亚大学医学院性病学系，Depok，IndonesiaWindy K。

Budianti & Retno W. SoebaryoOccupational Medicine Department, Faculty of Medicine, Universitas Indonesia, Depok, IndonesiaMuchtaruddin MansyurClinical Pharmacology Department, Faculty of Medicine, Universitas Indonesia, Depok, IndonesiaFranciscus D. SuyatnaPhysiology Department, Faculty of Medicine, Universitas Indonesia, Depok, IndonesiaMinarma SiagianFaculty of Pharmacy, Universitas Indonesia, Depok, IndonesiaJoshita DjajadisastraFaculty of Medicine, Airlangga University, Depok, IndonesiaCita R.

Budianti＆Retno W.Soebaryo印度尼西亚大学医学院职业医学系，Depok，IndonesiaMuchtaruddin Mansyurc印度尼西亚大学医学院临床药理学系，Depok，IndonesiaFranciscus D.SuyatnaPhysiology系，医学院，印尼大学，Depok，IndonesiaMinarma SiagianFaculty of Pharmacy，Universitas Indonesia，Depok，IndonesiaJoshita Djajadisatrafaculty of Medicine，Airlangga University，Depok，IndonesiaCita R。

S. PrakoeswaAuthorsWindy K. BudiantiView author publicationsYou can also search for this author in.

S、 PrakoeswaAuthorsWindy K.BudiantiView作者出版物您也可以在中搜索此作者。

PubMed Google ScholarRetno W. SoebaryoView author publicationsYou can also search for this author in

PubMed Google ScholarMuchtaruddin MansyurView author publicationsYou can also search for this author in

PubMed Google ScholarMuchtaruddin MansyurView作者出版物您也可以在

PubMed Google ScholarFranciscus D. SuyatnaView author publicationsYou can also search for this author in

PubMed Google ScholarFranciscus D.SuyatnaView作者出版物您也可以在

PubMed Google ScholarMinarma SiagianView author publicationsYou can also search for this author in

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PubMed Google ScholarJoshita DjajadisastraView author publicationsYou can also search for this author in

PubMed Google ScholarJoshita DjajadisastraView作者出版物您也可以在

PubMed Google ScholarCita R. S. PrakoeswaView author publicationsYou can also search for this author in

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PubMed Google ScholarContributionsI as the corresponding author declare each of the author's roles in this manuscript. dr. Windy Keumala Budianti (Me, as first author) created the main concept, collecting the data, editing, writing, analyzing, and reviewing the manuscript. As for the the other author's roles mentioned in this manuscript are as follow; Prof.

。Windy Keumala Budianti博士（我是第一作者）创建了主要概念，收集数据，编辑，写作，分析和审阅手稿。至于本手稿中提到的另一位作者的角色如下；教授。

Retno contributed in the concept making in dermatological field by her expertise Prof. Muchtaruddin contributed the concept making in occupational field as well as statistical analyzing Prof. Fransciscus D Suyatna contributed in the active ingredients preparation and the sample method Prof. Cita contributed in the editing and writing of the manuscript dr.

Retno以其专业知识为皮肤病学领域的概念制定做出了贡献。Muchtaruddin教授为职业领域的概念制定做出了贡献，统计分析Fransciscus D Suyatna教授为活性成分制备和样品方法做出了贡献。Cita教授为编辑和撰写手稿dr。

Minarma contributed in reviewing the manuscript Dr. Joshita contributed in the active ingredients preparation as a pharmacist expert.Corresponding authorCorrespondence to.

米纳玛（Minarma）参与了手稿的审查，乔希塔（Joshita）博士作为药剂师专家参与了活性成分的制备。对应作者对应。

Windy K. Budianti.Ethics declarations

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Reprints and permissionsAbout this articleCite this articleBudianti, W.K., Soebaryo, R.W., Mansyur, M. et al. Cocos nucifera and glycerine afterwork moisturizers for secondary prevention of hand dermatitis among fabric worker: a randomized, double-blind, cross over trial.

转载和许可本文引用本文Budianti，W.K.，Soebaryo，R.W.，Mansyur，M。等人。椰子和甘油润肤霜用于织物工人手部皮炎的二级预防：一项随机，双盲，交叉试验。

Sci Rep 14, 20702 (2024). https://doi.org/10.1038/s41598-024-72010-0Download citationReceived: 06 June 2023Accepted: 02 September 2024Published: 05 September 2024DOI: https://doi.org/10.1038/s41598-024-72010-0Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

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KeywordsBatik worker

关键词巴提克工人

Cocos nucifera

Nucifera公鸡

GlycerinMoisturizerPreventionOccupational hand dermatitis

甘油保湿剂预防职业性手部皮炎

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