Dermatology Online Journal

The role of soap in acne
Craig G Burkhart MD MPH
Dermatology Online Journal 12 (4): 19

Medical University of Ohio at Toledo. cgbakb@aol.com

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In clinical dermatology, there are few questions asked more commonly by acne patients than "What is the best way for me to cleanse my face?" In my office, we recently reversed this inquiry back to the patients by asking fifteen acne subjects the three characteristics that they most sought by their acne cleanser [1]. The list included smell, foam, thickness, ease of use rinse ability, softness, gentleness, moisturizing, soothing, and clean feeling. Each person was to select the three most important cosmetic features of a wash product for their situation. In order, the major traits sought were cleanliness feeling (11), moisturizing (9), gentleness (8), and pleasant smell (7). A previous study similarly reported that the most sought-after qualities of soap by consumers were safety, mildness, gentleness, less irritation, and less drying [2]. Of note, cleansing the skin, the main purpose for using soap, is no longer the desired endpoint [3, 4].

For generations, patients and physicians believed that successful treatment of acne depended on the degreasing of the skin to an extent which produces noticeable peeling [5]. In the 1980s, pharmaceutical companies began suggesting that irritation of the skin was not necessary for acne control. Going full circle, recent articles imply that acne can be exacerbated by external insults, such as harsh soaps, and that compliance is only achieved by products that are esthetically pleasing [6]. Nevertheless, there are still acne patients who benefit from aggressive washing of the face.

Washing meets various people's needs of hygiene, cosmesis, medical, social, cultural, and religious functions. It contributes to a feeling of well being as well as improving the appearance and smell of the skin. Rather than promoting health, its importance is in the feeling, appearance, and scent it imparts to the skin [2]. The formulation of a soap is closely tied to its marketing strategy (consumer needs, targeted consumer segment, purposes for which it is intended, and chosen distribution) as well as to the production process chosen and its intended technical characteristics) [7]. Mildness has become the major benefit claimed for soaps and testing for mildness now ranks among the first concerns of the manufacturing industry [8]. One could query whether this movement away from harsh soaps was lead by physicians, patients, or the pharmacologic industry.

In patient care, it is important to realize that cleansing is an important aspect of skin care because it not only removes unwanted dirt, soil, and bacteria from skin, but also removes dead surface cells, preparing skin to better absorb topically applied medications [6]. Paradoxically, skin cleansing also typically leads to weakening of the barrier in which many of the cleansers' surfactants interact with the proteins and lipids of the stratum corneum detrimentally [6]. Inasmuch as almost half of the population claims that they personally have sensitive skin [9, 10], it is important that products be acceptable for this populace so that they are able to use an acne cleanser for prolonged time intervals. The lesser dehydration and damage and patient discomfort may enhance patient compliance and thereby improve the chances for successful therapy [11, 12]. Nevertheless, there will be some patients who prefer soaps that remove more facial oils.

When opting for an acne cleanser, take into consideration that soaps emulsify dirt, oil, and microorganisms on the skin surface so that they can be easily removed. Likely prescription choices include Brevoxyl®-8 Creamy Wash, Triaz®-6 Wash, and Zoderm® Wash, which have the benefit of containing benzoyl peroxide, which has antibacterial, anti-comedonal, and exfoliative properties. Lipid-free cleansers, such as Cetaphil® and Moisturel®, are able to remove cosmetics and low level of environmental dirt, but can only remove bacteria and oil through mechanical means. More studies are needed to assess the best agent for acne control and to answer whether different agents may be attractive to groups with variant forms of acne.

References

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2. Wolf R, Wolf D, Tuzun B, Tuzun Y. Soaps, shampoos, and detergents. Clin Dermatol 2001;19:393-7.

3. Wolf R. Has mildness replaced cleanliness next to godliness? Dermatology 1994;189:217-21.

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9. Willis CM, Shaw S, DeLacharriere O, Baverel M, Reiche L. Sensitive skin: an epidemiological study. Br J Dermatol 2001;145:258-63.

10. Jourdain R, Lacharriere O, Bastien P, Maibach HI. Ethnic variations in self-perceived sensitive skin: epidemiological survey. Contact Dermatol 2002;46:162-9.

11. Nicoll G, Barrows J, Murahata R, Greene A, Leyden J, Grove G. Clinical implications of mild cleansing products for individuals undergoing acne therapy with tretinoin. J Europ Acad Dermatol Venereol 1995;5:S151

12. Gehring W, Gloor M, Kleesz P. Predictive washing test for evaluation of individual eczema risk. Contact Dermatol 1998;39:8-13.

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