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The Role of Cleansers in Skin Disorders

The Role of Cleansers in Skin Disorders

For humans, cleansing has come a long way beyond removing dirt. It is a ritual performed since historical times and has been an essential part of religious ceremonies and healthy living. In recent times, the act of cleansing is also seen as a way to improve the skin health and appearance1. As with all other skin products, a fine balance needs to be maintained between skin cleansing and the preservation of its function.

In earliest times, cleansing was done by using a hard object to scrape the skin. An oil, like olive oil, was often used in conjunction with this mechanical action as it helped to loosen dirt. Later civilizations used plant materials with water for cleansing. Many different civilizations can be given credit for discovering soap. The earliest mention of the soap making process can be found in Sumerian clay tablets from roughly 2000 BC. By 600 BC, tree ash and animal fat had been used by the Phoenicians to prepare soap. Roman legend says that soap was discovered near Mount Sapo, a site of animal sacrifices located outside Rome1. The importance of soap as a cleansing agent was recognised only after the first century AD. The Greek physician Galen (130–200 AD and the same physician credited for the “G” in our GF range) was the first to have written about the use of soap as a body-cleansing agent. The details of saponification - the process of soap making - was published in 17753. The English have been credited with developing the first wrapped soap bar in 1884. The soap market continued to expand and during the Second World war the development of synthetic detergents came as a major breakthrough1. Synthetic detergents now form the basis of many present-day skin-cleansing products.

Why do we need cleansers?

Many environmental impurities and cosmetic products are not water soluble, so washing the skin with water alone is not enough to remove them. A detergent, or soap, has the ability to attract both fat and water. Cleansers fit into this category. Skin cleansers are surface-active substances that remove impurities in an emulsified form. An ideal cleanser should do this without damaging or irritating the skin, on the contrary, it should try to keep the skin surface moist4.

Cleanser composition

Surfactants are the principal ingredients of most cleansers. The type and amount of surfactant in a cleansing agent has a direct influence on its skin drying and irritancy potential5.

Soap is the most commonly used surfactant in skin cleansers. However, soap can quite frequently cause dryness and irritation of the skin.

Types of Cleansers

Soaps

Composed of long-chain fatty-acid alkali salts with a pH of between 9.0 and 12.06.

Includes:

  • Glycerine (transparent) bars: contains glycerine to counter the drying effects of soap.
  • Super-fatted soaps: contain more fats such as lanolin, which provides a protective film on the skin.
  • Deodorant or antibacterial soaps: contain antibacterial agents such as triclosan to inhibit the growth of bacteria and thereby control odour.

Synthetic detergent bars of soap

These soaps have a non-soap synthetic surfactant as their principal ingredient. Synthetic surfactants, unlike soap, are not manufactured by saponification (combining an alkaline ingredient like caustic soda and a fat). They have a neutral or slightly acidic pH and are less irritating to skin and do not form a soap foamy layer. Microscopy has demonstrated that skin washed with synthetic detergents has well-preserved lipid and protein compared to significant damage after washing with soap7. The increased content of free-fatty acid provides a moisturising benefit that helps to maintain skin hydration3.

Lipid-free cleansing lotions

These lotions contain fatty alcohols and are suitable for people with sensitive or dry skin. They can be wiped off without water. The fatty alcohols in these lotions facilitate evaporation and so rinsability is high. When used on the face, there is less facial residue which is an advantage. These agents also contain emollients (for example fatty alcohols) and/or humectants (like propylene glycol) which counter the irritancy or drying potential of the surfactant5.

Liquid body washes

More convenient as well as being more hygienic than a traditional bar of soap. Employing milder surfactants and incorporating an increased amount of emollients (like lipid-free cleansers) they do not dry the skin as much as soaps3.

Adverse effects of soaps

Harsh cleansers such as soaps are known to cause:

  1. After wash tightness of the skin. The rapid evaporation of water from the skin surface causes this tightness7.
  2. Skin dryness, scaling and roughness. Fat solvents such as alcohol, and even non-ionic surfactants, can cause dryness of the skin and have the long-term effect of causing environmental damage to the skin7.
  3. Skin irritation, along with erythema and itching, results from damage to the skin’s barrier7 caused by using harsh soaps.
  4. Allergic contact dermatitis from fragrances, preservatives, or dyes present in some soaps.

Cleanser factors causing dryness and irritation

The major factors affecting the drying and irritancy potential of cleansers are:

  1. The type of surfactant:
    Surfactants, after binding to keratin, cause protein denaturation. This leads to damage in the cell membrane of keratinocytes. In turn this leads to adverse cutaneous responses5.
  2. The rinsability of the cleanser:
    The irritancy potential of a cleansing agent may increase the longer it is left on the skin5.
  3. The pH3 of the cleansing agent:
    Maintaining the skin surface at its physiological pH (5.50) during cleansing prevents overgrowth of certain microorganisms, like Propionibacterium acnes. Soaps with an alkaline pH cause damage to the lipid bilayer of the stratum corneum thus causing dryness of the skin and long term environmental damage5. Synthetic detergents have a neutral or slightly acidic pH which closely matches the skin’s pH.

Considering all these factors, it can be concluded that synthetic detergents have the least irritancy potential compared to other products.

Use of cleansers in various dermatological disorders

Atopic dermatitis

Atopic dermatitis (AD) develops as a result of a complex interrelationship between environmental, immunologic, genetic, and pharmacologic factors9. Several trigger factors such as irritants (soap and detergents, occupational irritants and disinfectants), microorganisms (Staphylococcus aureus, viruses and dermatophytes), aeroallergens, seasonal changes, and psychogenic factors may aggravate the disease.

Washing twice daily with a classic alkaline soap (pH 10.2) has shown to increase suffering from atopic dermatitis. This damage to the skin barrier function could result in increased colonization of gram-positive bacteria5

Synthetic washing bars are a good choice for cleansing in these cases. Their mildness and ability to maintain proper hydration of the stratum corneum are good for the atopic dry skin10.

Cleansing in acne

The goal of cleansing for acne, or acne-prone skin, is to gently remove surface dirt, sweat, and excessive skin lipids without irritating or drying the skin. The ideal cleanser for acne skin should be:

  • non-comedogenic,
  • non-acnegenic,
  • non-irritating, and
  • non-allergenic11.

A common misconception associated with acne is that vigorous scrubbing of the skin with soap and water several times a day will reduce the oiliness. However, this only leads to an aggravation of the acne, and sometimes even may cause acne detergicans.

A fragrance-free liquid cleanser with good rinsability is the preferred cleanser for acne11.

Cleansing in rosacea

The skin of people with rosacea is extremely sensitive to chemical irritants. It is best to avoid classic soaps, cleansers containing alcohol, astringents, and abrasives. Ideally only very mild cleansing agents should be used in these cases5.

Therapeutic skin cleansers, containing sulfacetamide 10% and sulphur 5%, in addition to a synthetic detergent, are approved for the treatment of rosacea13. Gentle cleansing is also recommended with rosacea.

Cleansing environmentally damaged skin

Excessive long-term exposure to sunlight, pollution and harmful cosmetic ingredients damages the skin, and is known to cause premature ageing and skin cancer. Liquid cleansers with a pH close to that of the skin should be used.

Contact dermatitis

Contact dermatitis, both irritant and allergic, are of special concern. Prevention is the key to reduce the incidence of contact dermatitis. Avoidance of causative irritants, both at home and the workplace, is the primary treatment of contact dermatitis14, 15.

While liquid synthetic detergents are generally perfectly adequate for cleansing hands at home, more powerful hand cleansers are needed for the removal of heavy-duty industrial soiling such as oil, grease, paints, and lacquer. Products free from abrasive agents e.g. tiny plastic beads or a scouring sponge are usually skin friendly and preferred by dermatologists14.

Cleansing sensitive skin

Dermatologists and cosmetic scientists define “sensitive skin” as that which exhibits contact irritant or allergic reactions more readily than the average population16, 17.

This increased reactivity to external factors can be due to genetic factors or environmental damage to the skin

People who have sensitive skin should use very mild cleansing agents. Liquid facial cleansers are highly effective and beneficial for sensitive skin4. Topical retinoids, used in a wide variety of dermatological disorders, increase skin susceptibility to irritation. In these cases, use a cleanser that does not aggravate the state of this weakened stratum corneum. Lipid-free cleansers containing humectants may help lessen the symptoms of these disorders.

Facial chemical peels and laser-treated skin are more common as these cosmetic procedures become more popular for treating photoaging, wrinkles, scars, and discolouration. These treatments produce a controlled injury to the skin that promotes the growth of new skin with an improved appearance. Since the skin is vulnerable following one of these procedures, during the subsequent period of epithelial regeneration, a mild cleansing agent is recommended to avoid adverse reactions10.

Cleansing the skin when using the Thoclor GF range of products

Cleansers have evolved significantly from just serving as cleaning agents for the removal of sebum, dirt, dead cells and microorganisms from the skin. This has come about to meet the challenge of ever-changing consumer expectations. It has been shown that the pH of the cleanser is important in preserving the skin’s acid mantle and to protect the bacterial flora that is responsible for maintaining a healthy skin environment. The benefits of using gentle liquid cleansers which are usually formulated at a slightly acidic pH, further benefit the skin.

Thoclor GF products are manufactured to function best at a slightly acidic pH level. It is, therefore, necessary to preserve the skin’s pH when using a cleanser, as the alkaline pH that results from using a harsh soap cleanser will also disrupt the pH of the GF range and diminish the effect of the HOCl immune molecule. Never use soap when using our products, but instead use a liquid detergent cleanser with an acidic pH.

References

  1. Ertel K. Modern skin cleansers. Dermatol Clin. 2000;18:561–75. [PubMed: 11059364]
  2. Gelmetti C. Skin cleansing in children. J Eur Acad Dermatol Venereol. 2001;15:12–5. [PubMed: 11720072]
  3. Abbas S, Goldberg JW, Massaro M. Personal cleanser technology and clinical performance. Dermatol Ther. 2004;17:35–42.[PubMed: 14728697]
  4. Kuehl BL, Fyfe KS, Shear NH. Cutaneous cleansers. Skin Therapy Lett. 2003;8:1–4. [PubMed: 12858234]
  5. Bikowski J. The use of cleansers as therapeutic concomitants in various dermatologic disorders. Cutis. 2001;68:12–9.[PubMed: 11845951]
  6. Draelos ZD. Cosmetics and cosmeceuticals. In: Bolognia JL, Jorizzo JL, Rapini RP, editors. Dermatology. 2nd ed. Philadelphia: Mosby Elsevier; 2008. pp. 2301–2.
  7. Ananthapadmanabhan KP, Moore DJ, Subramanyan K, Misra M, Meyer F. Cleansing without compromise: The impact of cleansers on the skin barrier and the technology of mild cleansing. Dermatol Ther. 2004;17:16–25. [PubMed: 14728695]
  8. Lakshmi C, Srinivas CR, Anand CV, Mathew AC. Irritancy ranking of 31 cleansers in the Indian market in a 24-h patch test. Int J Cosmet Sci. 2008;30:277–83. [PubMed: 18713074]
  9. Habif TP. In Clinical Dermatology: A color guide to diagnosis and therapy. 4th ed. Philadelphia: Mosby Elsevier; 2004. Atopic dermatitis.
  10. Subramanyan K. Role of mild cleansing in the management of patient skin. Dermatol Ther. 2004;17:26–34.[PubMed: 14728696]
  11. Solomon BA, Shalita AR. Effect of detergents in acne. Clin Dermatol. 1996;14:95–9. [PubMed: 8901406]
  12. Toombs EL. Cosmetics in treatment of acne vulgaris. Dermatol Clin. 2005;23:575–81. [PubMed: 16039436]
  13. DelRosso JQ. Adjunctive skin care in the management of Rosacea: Cleansers, moisturizers, and photoprotectants. Cutis. 2005;75:17–21.
  14. Klotz A, Veeger M, Rocher W. Skin cleansers for occupational use: Testing the skin compatibility of different formulations. Int Arch Occup Environ Health. 2003;76:367–73. [PubMed: 12768428]
  15. Ortonne JP. Skin cleansing: An important problem in occupational dermatology. Wien Med Wochenschr Suppl. 1990;108:19–21. [PubMed: 2147305]
  16. Casper KA, Mehta BH. Healthy skin for women; A review of common conditions and therapies. J Am Pharm Assoc. 2002;42:206–16.
  17. Simion AF, Rau AH. Sensitive skin: What is it and how to formulate for it. Cosmet Toiletr. 1994;109:43s.
  18. Draelos ZD. Sensitive skin: Perceptions, evaluation, and treatment. Am J Contact Dermat. 1997;8:67–8.

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