Cleansers and Cleansing

The art of cleansing has progressed immensely over several thousand years from simply scraping the skin to an exercise in relaxation and improvement in the skin's health and appearance in the present day.

Soaps – the basic cleansing agent has also undergone a sea change in its evolution with many variants and newer constituents being incorporated into it. In dermatological disorders like acne, rosacea, atopic dermatitis, photoaging, ‘sensitive skin’, occupational dermatosis cleansers may have a beneficial role along with other therapeutic measures. With the advent of aesthetic dermatology, the act of cleansing and the use of various cleansing agents prior to aesthetic procedures has also assumed significance.

Cleansing has come a long way beyond dirt removal. It is a ritual performed by us since the time of his origin and has been an essential part of religious ceremony and belief. In recent times, the act of cleansing to many people serves as a means of relaxation and escape from the vagaries of everyday life, and also as a way to improve the skin health and appearance. Irrespective of the outlook, a fine balance needs to be maintained between skin cleansing and the preservation of its homeostatic properties.

Many of the environmental impurities and cosmetic products are not water soluble and so washing the skin with simple water would not be sufficient to remove them. Substances capable of emulsifying them into finer particles are to be used for making these fat soluble impurities water soluble. Herein, cleansers fit into the picture. Skin cleansers are surface—active substances (i.e. emulsifiers/detergents/surfactants/soaps) that lower the surface tension on the skin and remove dirt, sebum, oil from cosmetic products, microorganisms, and exfoliated corneum cells in an emulsified form. An ideal cleanser should do all these without damaging or irritating the skin, on the contrary it should try to keep the skin surface moist.

Surfactants are the principal constituents of most cleanser formulas and are mainly responsible for its cleansing action. Surfactants move to the interface upon dissolving in water and act by lowering the interfacial tension. Surfactants can be ionic, non-ionic, and silicone containing. Ionic surfactants based on their polar portions can be anionic (– ively charged), cationic (+ively charged), and amphoteric (both + and – ively charged). The type and amount of surfactant in a cleansing agent has a bearing on its drying and irritancy potential.

The major factors affecting the drying and irritancy potential of cleansers, include type and "rinsability" of surfactant ingredients and to a lesser degree pH:

1. Surfactant ingredients: Surfactants after binding to keratin cause protein denaturation, thus leading to damage to the cell membrane of keratinocytes. This in turn leads to adverse cutaneous responses. Surfactant chain length is also an important factor in determining the irritant potential. Although anionic surfactants are considered to have the greatest irritancy potential, their proportion in a cleansing agent and their combination with cationic acrylate polymers or non-ionic surfactants and humectants like propylene glycol modifies the irritation potential.

2. Skin cleanser residue or "rinsability" factor: The irritancy potential of a cleansing agent may increase the longer it is left on the skin. Residual levels of different products on the skin vary, and these levels correlate with irritation reactions.

3. pH of cleansing agent: Although controversial, but still many dermatologist believe that maintaining the skin surface at its physiological pH (4–6.5) during cleansing prevents overgrowth of certain microorganisms, like Propionibacterium acnes. Soaps with an alkaline pH have also been said to cause damage to the lipid bilayer of the stratum corneum thus causing dryness of the skin. However, other workers have shown that the pH of a cleanser appears to have little effect on its role in damaging the skin. Present day synthetic detergents and lipid free cleansers have a neutral or slightly acidic pH which closely matches the skin pH.

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:

1. non comedogenic,

2. non acnegenic,

3. non irritating, and

4. non allergenic.

   
   

The myth associated with acne that vigorous scrubbing of the skin with soap and water several times a day will reduce the oiliness; however, only leads to an aggravation of acne and sometimes even may cause Acne Detergicans.

The skin of patients with Rosacea is extremely sensitive to chemical irritants. It is better to avoid classic soaps, cleansers containing alcohol, astringents, and abrasives in these patients. Ideally, only very mild cleansing agents should be used here. If more irritating cleansing agents are used they should be diluted extensively.

Therapeutic skin cleansers, containing sulfacetamide 10% and sulfur 5% in addition to a synthetic detergent, are approved for the treatment of Rosacea. Vigorous cleansing should however be avoided. The only contraindication to their use being a known hypersensitivity to sulfonamides, sulfur, or other components. Gentle cleansing is recommended in cases of Rosacea.

Dermatologists and cosmetic scientists define “sensitive skin” as that which exhibits contact irritant or allergic reactions more readily than the average population. This increased reactivity to external factors can be due to:

1. physiologic phenomenon,

2. heightened neurosensory input,

3. increased immune responsiveness and/ or

4. compromised barrier function.

   
   

Those who have sensitive skin should use very mild cleansing agents. Liquid facial cleansers are highly effective and beneficial for sensitive skin. These can also be used synergistically with topical or systemic therapy.

Topical retinoids used in a wide variety of dermatological disorders increase skin susceptibility to irritation. In these cases, one should use a cleanser that does not aggravate the state of their weakened barrier. The humectants and emollients found in lipid-free cleansers could help lessen the symptoms of these disorders.

Facial chemical peels are rapidly becoming popular as cosmetic procedures for treatment of photoaging, wrinkles, scars, and discoloration. Peeling produces controlled injury to the skin that promotes the growth of new skin with an improved appearance. Since the skin is vulnerable following the procedure and subsequent period of epithelial regeneration, mild cleansing agents are to be used to avoid adverse reactions

There is a wide spectrum of skin cleansing agents for acne prone patients ranging from lipid free cleansers, syndets (synthetic detergents), astringents, exfoliants, and abrasives The major side effects of most antiacne therapies are dryness and irritation of the skin, so gentle cleansing is important in these group of patients. A non-ionic, fragrance-free dermatologic bar or liquid cleanser with good rinsability is the preferred cleanser in acne. The cleansing regimen should suit the needs of the individual.

Cleansers have evolved significantly from just serving as cleaning agents for removal of sebum, dirt, dead cells, and microorganisms from skin mainly because of the challenge of meeting the ever changing consumer expectations. With the advent of advanced technologies, newer cleansers are now being manufactured which are mild, provide moisturising benefits and can be easily washed off. In various dermatological disorders, all these properties of modern cleansers enable them to be used concomitantly with topical therapeutic measures thus influencing the outcome of treatment and progression of the disorders.

Not my own work. Taken from:

Mukhopadhyay P. Cleansers and their role in various dermatological disorders. Indian J Dermatol. 2011 Jan;56(1):2-6. doi: 10.4103/0019-5154.77542. PMID: 21572782; PMCID: PMC3088928.

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