Surfactant Skincare Series – Impact on Eczema Skin

This week, we’re looking at the research surrounding Surfactants on Atopic Dermatitis. First a recap of eczema skin and its ‘compromised’ characteristics that warrant special care during skin cleansing.

The defective skin barrier in atopic dermatitis makes it:

–    Increased skin permeability

–    Increased transepidermal water loss

–    Increased bacterial colonization

–    Reduced antimicrobial peptides (AMP) expression, possibly resulting in higher incidences of infection

–    Elevated skin pH

The above makes eczema skin more prone to irritants and more vulnerable to the ‘harsh’ effects of surfactants, discussed last week:

  • Alkalization –  Elevated skin pH has the impact of (i) reducing skin lipids (ii) allows for growth of harmful bacteria like staph bacteria and (iii) increases transepidermal water loss (TEWL)
  • Damage to Skin Lipids
  • Damage to Skin Cells
  • Toxic to Skin Cells
  • Irritation to Skin

Research on Surfactant Impacts on Eczema Skin

Much of the research focuses on certain surfactant ingredients, as below:

A defective skin barrier requires careful selection of cleansing product

A defective skin barrier requires careful selection of cleansing product

(I) Chlorhexidine Gluconate is the antiseptic for use on eczema skin as it causes the least atopic dermatitis skin lesions.

This is from a study examining the Effect of Hand Antiseptic Agents Benzalkonium Chloride, Povidone-Iodine, Ethanol, and Chlorhexidine Gluconate on Atopic Dermatitis in NC/Nga Mice. The four common antiseptic agents in hand sanitizers are:

Benzalkonium Chloride (BZK): A Cationic detergent with strong antiseptic activity, more gentle than that of ethanol-based BUT with reported contact dermatitis cases

Povidone-iodine (PVP-I) – Commonly use in mouthwash and in disinfection before surgery, low toxicity in humans BUT with reported contact dermatitis cases

Ethanol (Et-OH) – Broad antibacterial and antiviral spectrum BUT result in rough hands because of its strong defatting effect on the skin

Chlorhexidine gluconate (CHG)Broad antibacterial spectrum AND with low incidences of contact dermatitis

(II) Reduce the use of Sodium Lauryl Sulphate (SLS)

In a study involving twenty volunteers with atopic dermatitis, it was found that repeated exposure to sodium lauryl sulphate and sodium hydroxide lead to a more pronounced impairment of the skin barrier function and significant transepidermal water loss.

SLS is a known skin irritant that damages the lipid barrier, causing inflammation and detachment of the skin layers (denaturation discussed last week).

(III) Reduce Cocamidopropyl Betaine (CAPB)

In another study involving 1674 patients, atopic dermatitis was associated with contact hypersensitivity to cocamidopropyl betaine (CAPB), but not to cocamide diethanolamide DEA or amidoamine. CAPB is an amphoteric surfactant, that is considered milder than SLS and a very common surfactant in many products. However, CAPB is cytotoxic, i.e. toxic to skin cells.

(IV) The Use of Hydrophobically modified polymers (HMPs)

The recent studies on surfactants are in agreement that for patients with skin conditions, a gentle liquid cleanser containing HMPs are more appropriate. Addition of cationic polymers to skin cleansers can further protect the skin and improve moisturization. To further improve cleanser mildness, adding hydrophobically modified polymers (HMPs) to cleansers make it less irritating to the skin. This is due to the formation of larger micelle of the surfactant, i.e. the larger the less likely to penetrate and remove skin lipids.

Above is similar to the care to note when cleansing baby skin, as well as what to use/ avoid to limit the harmful effects of surfactants on skin discussed in the previous two weeks. For all the posts in this Surfactant Skincare Series, see:

  1. Surfactants and Functions
  2. Cleansing Baby Skin
  3. Impact on Skin

References

Surfactant Skincare Series – Impact on Skin

This month, we’re looking at surfactants – the chemical agents in cleansing products. It is important because while surfactants play an important cleansing function, they also potentially cause skin irritation. Last two weeks, we have understood:

  1. Different groups of surfactants and their functions – Anionic, Cationic, Amphoteric and Non-ionic surfactants
  2. What to Look out for when Cleansing Baby Skin – Discussion on the use of liquid cleanser being preferable to water, and what to look out for in the choice of liquid cleanser

Today, we’re looking more in-depth into how surfactants interact with skin and the potential harm to our skin.

Surfactants, while cleanse and remove oil soluble dirt/sebum, also potentially damage skin cells and lipids

Surfactants, while cleanse and remove oil soluble dirt/sebum, also potentially damage skin cells and lipids

Alkalization – The traditional soap is alkaline in nature (pH of 9 and above) and the alkalinity will increase the skin pH (which is of pH 4.6 to 5.6). Modifying the skin pH to more alkaline than it is supposed to be has the impact of (i) reducing skin lipids, including ceramides (ii) allows for growth of harmful bacteria like staph bacteria that thrives in a more alkaline environment and (iii) increases transepidermal water loss (TEWL). Alkaline soap is able to dissolve both fat and water-soluble components of skin. Synthetic cleansers are of varying pH and able to modify the pH of the cleansing product.

Damage to Skin Lipids – Surfactants are able to clean dirt and sebum that are oil-soluble. However, this property also means that surfactants may inadvertently solubilize the skin natural lipid membranes (ceramides). Stronger anionic surfactants like Sodium Lauryl Sulphate (SLS) enhances penetration into the skin and able to affect the deeper skin cells (skin lipids).

Damage to Skin Cells – During washing, the surfactants interact with the skin cells and collagen fibers and cause temporarily swelling and hyper-hydration. Once the water evaporates, there is destruction of the skin protein structures (known as denaturation) and leads to skin dryness, roughness, tightness and scaling. This is an adverse effect of anionic surfactant.

Toxic to Skin Cells – Known as cytotoxicity, surfactants can permeate skin cells and cause irreparable alteration. Certain surfactants such as benzalkonium chloride and cocamidopropyl betaine (CAPB) are known to be more cytotoxic than SLS.  CAPB is an amphoteric surfactant, a group of surfactant less irritating than anionic surfactant (SLS belongs to anionic group) but nonetheless can be cytotoxic. CAPB is also associated with allergic contact dermatitis.

Irritation to Skin – This is related to the duration of exposure, frequency, concentration and individual skin type. SLS is a known irritant that can cause skin inflammation (irritant contact dermatitis) and when combined with triclosan (an antibacterial and antifungal agent in products), can stay on the skin for hours/days. Amphoteric and nonionic surfactants are considered to be less irritating to skin. (Note: Skin irritation and cytotoxity are different concepts.)

What to Note when Choosing Cleansing Products

Based on the above surfactant interaction with skin, it follows that we ought to choose:

  • Products close to the skin pH (even water is not, either neutral pH 7 or sometimes more alkali)
  • It follows then to avoid soaps, which by nature are alkaline
  • Avoid SLS, as it can penetrate, damage and irritant skin
  • Avoid CAPB as it is cytotoxic
  • Choose products with larger micelles as they do not penetrate the skin cells as much (product packaging may not indicate this information so it’s quite hard to know; look out for Polyethylene oxide (PEO)/ PEO Sorbitan Laurate which forms larger micelles in the surfactant or for the term Hydrophobically Modified Polymers (HMPs))
  • Choose cleansing products that are moisturizing and moisturize right after washing
  • Reduce washing for prolonged time and frequent washing
  • Avoid alcohols, gels and alphahydroxy acids that can cause stinging
  • Avoid perfume, benzoyl peroxide, preservatives, parabens, propylene glycol, lanolin, methylisothiazolinone and other top irritants in this post
  • Avoid ingredients ending with sulfates

It is not easy to find a cleanser without any of the above-mentioned ingredient. For those with sensitive skin, it may be better to not wash as often and take care to choose a hypoallergenic product. Try to read the ingredient label of your product and be sure that the first few ingredients are at least not those in this post.

References

Surfactant Skincare series – Cleansing Baby Skin

Last week, we briefly looked at the different types of surfactants and understand their functions. This week, we’re looking deeper into baby skin and the research around cleansing baby skin.

Baby Skin Structural Vulnerabilities

In the Skin Fact series, we’ve discussed much about baby skin structural differences. Below is a recap of certain baby skin characteristics that increase its vulnerability during skin cleansing:

Higher transepidermal water loss due to thinner stratum corneum – More vulnerable to water loss during bathing and skin barrier breakdown when there’s excessive friction (from over-washing or from rubbing skin when toweling dry).

High surface-area to volume ratio – along with a thinner stratum corneum and immature drug matebolism, make baby skin more vulnerable to harmful chemicals used during bathing

Less total lipids – make it vulnerable to further reduction of skin lipids lost during washing

Cleansing Baby Skin – Research on What’s Best

From a search on Pubmed for review articles on the research for baby skin cleansing, there’s actually not much research on it. From a 2009 European round table meeting, the consensus is:

Learning about cleansers for Baby Skin

Learning about cleansers for Baby Skin

  1. Liquid cleansers in bathing are beneficial over water alone – Water cannot remove dirt, oil that can only be removed by oil. Prolonged washing with water dries the skin and depending on the pH of the water itself, it may be more alkaline than the natural pH of the skin.
  2. Liquid cleanser are preferred, rather than soap which alters the skin pH and affect the skin lipids, increase skin drying and irritation – Learn more about soap and its impact on skin pH in the skin pH series. The pH of skin can affect its skin lipids, which (a lower skin lipids) in turn causes drying, itchiness and skin inflammation.
  3. Liquid cleanser should be mild, non-irritating, non-stinging (especially to the eyes as babies may not be able to blink fast enough) and non-pH altering, and contains moisturizing function

For cleansing of baby’s skin, I’ve found two other articles that offer recommendation on what’s best for baby skin.

Extracted from http://www.hindawi.com/journals/drp/2012/198789/tab2/ - Review article on The Infant Skin Barrier: Can We Preserve, Protect, and Enhance the Barrier?

Extracted from http://www.hindawi.com/journals/drp/2012/198789/tab2/ – Review article on The Infant Skin Barrier: Can We Preserve, Protect, and Enhance the Barrier?

Apart from the three points above, additional points are:

4. Avoid Anionic Surfactants, these are those that cleanse very well but most irritating to skin, an easy way to identify them is to look out for those chemicals ending with Sulfates.

5. Choose those with large head groups and have the ability to form larger micelles. Surfactants organize into groups of molecules called micelles and generally the larger these micelles are, the less irritating the surfactant is. This is related to larger micelles being less able to penetrate the outer layer of skin (stratum corneum).

6. No preservatives is not best as bacterial growth can happen in such products

7. No scent does not mean no fragrance (potential irritant) is used, it can be one fragrance masking that of another.

Why Baby Skin needs Cleansing

Just like last week we asked the question ‘Why not just use water to clean?‘ (because 40% of dirt, oil can only be removed by oil), we also have to understand why baby skin needs cleansing. Baby skin has saliva, nasal secretions, urine, feces, germs and dirt which can potentially irritate the skin when left on the skin. It is also possible that both skin allergy and the body (ie food allergy) can develop from foods being left on the skin for too long. It is therefore important to clean baby skin. However, baby skin, given its structural vulnerabilities, should not be over-washed and to avoid using baby wipes on face or baby wipes that are non-hypoallergenic, especially those containing fragrance and MI.

Next week, I’d (make a brave) attempt to look into how surfactants affect skin and in particular, impact on eczema skin. It’s a very ‘chemical’ topic and not easy, so appreciate if there’s feedback to improve on the blog post, and share your best cleanser!

References

Surfactant Skincare series – Surfactants and Functions

Kicking off Wednesday posts in 2016, like to explore this group of ingredients which is present in all cleansers but also have the potential to irritate skin.

Surfactants are ingredients that are active on surfaces, mainly to lower the surface tension on the skin and remove dirt, sebum, oil from cosmetic products, microorganisms and exfoliated skin cells in an emulsified form to be washed off. The different type of surfactants affect their cleansing, foaming/ lathering, emulsifying, solubilizing abilities as well as its potential to irritate.

Why not just Water?

Before we go on, the simple question to ask is why not just use water to clean our skin. This is because water alone is not effective in removing dirt which can be removed only by oil. Hydrophilic dirt can be removed only by water, and fat-soluble lipophilic dirt only by oils.

Groups of Surfactants

Surfactants are divided into hydrophilic (water loving), hydrophobic (water repelling) and lipophilic (oil loving). Surfactants consist of a fat-soluble (lipophilic) part and a water-soluble (hydrophilic) part. The lipophilic part sticks to oil and dirt, and the hydrophilic part allows it to be washed away.

Surfactants - learning about this group of ingredients that can clean but also irritate eczema skin

Surfactants – learning about this group of ingredients that can clean but also irritate eczema skin

Surfactants perform different functions, namely:

  1. Cleansing
  2. Emulsification – arrange itself at interface between two immiscible liquids to create an emulsion
  3. Solubilization – blending oily solution into clear liquid
  4. Conditioning
  5. Wetting – increase contact between the product and dirt

Apart from functions, manufacturers also consider mildness, biodegradability, toxicity, moisturization, skin appearance and feel, smell (fragrance) and lubrication when formulating their products.

There are four major groups of surfactants, classified by their polar hydrophilic (water loving) head group:

  1. Anionic
  2. Cationic
  3. Amphoteric
  4. Non-Ionic

Anionic Surfactants – Negative charge

Give effective cleansing and foam, good wetting properties, excellent lather characteristics, but moderate disinfectant properties and also likely to irritate skin.

E.g. Carboxylic acids – Stearic acid for stick products like deodorants and antiperspirants; Sodium stearate for soap

Sulfates – give effective cleansing, foaming and cheap; common irritant, e.g. Sodium lauryl sulfate (SLS), an alkyl sulfate used in detergents; Sodium laureth sulfate (SLES), an alkyl ether sulfate used in shampoo

Sulfonic acid surfactants – more expensive than sulfates but less irritating, e.g. dioctyl sodium sulfosuccinate, alkyl benzene sulfonate

Taurates (derived from taurine), Isethionates, Olefin sulfonates, and Sulfosuccinates.

Phosphate esters – Alkyl aryl ether phosphates; alkyl ether phosphates

Cationic Surfactants – Positive charge

Effective for conditioning cosmetics, positive charge makes the surfactants electrostatically attracted to the negative (damaged) sites on hair and skin protein which makes them resist rinse-off. Difficult to ‘mix’ with Anionic Surfactants. Also irritate. May be used as antimicrobial preservatives due to ability to kill bacteria.

E.g. Amines

Alkylimidazolines

Alkoxylated Amines

Quaternized Ammonium Compounds (or Quats). e.g. Cetrimonium chloride and Stearalkonium Chloride

Amphoteric surfactants – both positive and negative charge (depending on environment)

Help improve foaming, conditioning and reduce irritation. Moderate antimicrobial activity. Used in mild cleansing products, but not effective cleansers and emulsifiers. Both Alkaline and Acid, help to adjust the pH of the water used in solution.

E.g. Sodium Lauriminodipropionate and Disodium Lauroamphodiacetate.

Cocamidopropyl betaine, cocoamphoacetate and cocoamphodiacetate

Non ionic Surfactants – No charge

Used in heavy thick creams, such as hand or body creams, as  emulsifiers, conditioning ingredients, and solubilizing agents.

Relatively low potential toxicity and they are considered the most gentle surfactants, but they are also the most expensive 

Able to solubilize fatty acids and cholesterol in skin, thus may remove skin lipids

E.g. Cocamide DEA (coconut diethanolamide), widely used in personal care products for its thickener property and foam booster

Fatty acid esters of fatty alcohols, sorbitan esters, sucrose and cholesterol derivatives used like emulsifiers

In the following Wednesdays of this month, we will explore the impact of surfactants on skin, baby and eczema skin and some of the research in this area. I’m learning much about this as I read as well and it’s not all so easy to understand! Any expert reading this who would like to help out are welcomed, do leave a comment if you have expertise in this area or there’s something to correct in my post (no offense will be taken!).

References

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