MILD SOAPS
Place in Therapy
The evidence for the use of mild syndet bar soaps is conflicting. One study showed the Dove syndet bar reduced disease severity according to the EASI criteria (p<0.01)1. Patients perceived an improvement in skin condition over the 4-week study period. Negative features such as itching, tightness, tingling, irritation, and dryness were assessed to be reduced, while positive features such as smoothness, softness, and overall appearance were assessed to be enhanced1. However another study found that bar soaps were found to be discontinued by patients more often than soapless cleansers due to erythema2. A review article evaluated the evidence in the literature for the use of skin cleansers and moisturizers in atopic dermatitis. Cetaphil gentle skin cleanser was well tolerated and reduced the severity of eczematous lesions and maintained hydration while water alone resulted in persistent eczematous lesions despite topical corticosteroids2.
A study in 2004 evaluated a synthetic detergent bar soap applied with a cotton washcloth (patients were already treated with 0.05% flucinonide) and a petrolatum-delivering body wash applied with a polyethylene puff (patients were already treated with 0.1% triamcinolone acetonide) moderate xerotic eczema3. Moderate xerotic eczema had cleared in 86.2% of patients assigned to the body wash/puff cleansing system, compared to 51.9% of patients assigned to the beauty bar synthetic cleanser/washcloth cleansing system. The number of patients responding to the body wash/puff cleansing system was significant (P < .01).
For atopic dermatitis, in general, excessive washing should be avoided since it can remove natural lipids in the skin. It is recommended to use a mild nonalkaline soap or a soap free cleanser daily4.
References
1. Solodkina G, Yan X, Johnson AW, Gottlieb AB. Mild synthetic detergent bars are helpful for patients with atopic dermatitis. Poster presented at the American Academy of Dermatology 60th Annual Meeting, New Orleans, LA, February 22–27, 2002
2. Cheong et al. Gentle Cleansing and Moisturizing for Patients with Atopic Dermatitis and Sensitive Skin. Am J Clin Dermatol 2009; 10 Suppl. 1: 13-17
3. Zoe Diana Draelos, Keith Ertel, Paula Hartwig, and Gayle Rains, BA. The effect of two skin cleansing systems on moderate xerotic eczema. J Am Acad Dermatol. 2004
A study in 2004 evaluated a synthetic detergent bar soap applied with a cotton washcloth (patients were already treated with 0.05% flucinonide) and a petrolatum-delivering body wash applied with a polyethylene puff (patients were already treated with 0.1% triamcinolone acetonide) moderate xerotic eczema3. Moderate xerotic eczema had cleared in 86.2% of patients assigned to the body wash/puff cleansing system, compared to 51.9% of patients assigned to the beauty bar synthetic cleanser/washcloth cleansing system. The number of patients responding to the body wash/puff cleansing system was significant (P < .01).
For atopic dermatitis, in general, excessive washing should be avoided since it can remove natural lipids in the skin. It is recommended to use a mild nonalkaline soap or a soap free cleanser daily4.
References
1. Solodkina G, Yan X, Johnson AW, Gottlieb AB. Mild synthetic detergent bars are helpful for patients with atopic dermatitis. Poster presented at the American Academy of Dermatology 60th Annual Meeting, New Orleans, LA, February 22–27, 2002
2. Cheong et al. Gentle Cleansing and Moisturizing for Patients with Atopic Dermatitis and Sensitive Skin. Am J Clin Dermatol 2009; 10 Suppl. 1: 13-17
3. Zoe Diana Draelos, Keith Ertel, Paula Hartwig, and Gayle Rains, BA. The effect of two skin cleansing systems on moderate xerotic eczema. J Am Acad Dermatol. 2004
- Patient Self-Care, 1st Edition; Canadian Pharmacists Association Chapter 41: Dermatitis (Atopic, Contact and Stasis Dermatitis) Author: Debra Sibbald, BScPHM, MA