Antibacterial soap overuse may help spread disease
By Ed Susman
SPECIAL TO MSNBC
ANAHEIM, Calif., Aug. 1 — Scrubbing your hands is
the first line of defense against bacteria and other
germs that can cause colds, the flu, skin problems
and even deadly communicable illnesses. And
many people believe that antibacterial potions
work even better at stopping disease. But now
researchers say that too much of a good thing can
have the opposite effect — spreading disease
instead of preventing it.
THE QUESTION of whether overuse of antibacterial
soaps is contributing to the emergence of drug-resistant
superbugs is still a matter of debate. But some experts say
there is no doubt that too much hand-washing can create an
environment that allows bacteria to flourish and spread.
When overused, the relatively harsh detergent action of
antibacterial soaps leaves you vulnerable to open sores that
can attract bacteria, resulting in skin problems such as
eczema, doctors said here at the summer scientific meeting
of the American Academy of Dermatology.
This begins a vicious cycle, whereby a person who
develops hand eczema or another form of dermatitis
touches a surface, leaving microscopic germs behind.
Another person comes along, touches that surface and he
too can be infected with the bacteria, said Dr. Marianne
O’Donoghue, associate professor of dermatology at
Rush-Presbyterian St. Luke’s Medical Center in Chicago.
Similarly, bacteria can directly jump from a person with
dermatitis to an uninfected person when they shake hands,
she said.
“There is nothing quite as good to spread bacteria as
hand eczema,” O’Donoghue said.
Dr. William Baugh, chief of dermatology at the Beaufort
Naval Hospital in Beaufort, S.C., agreed. “I’ve seen patients
who have developed hand eczema from these [antibacterial]
products,” he said. “It certainly can occur [and spread].”
Ironically, the very people who believe that frequent
hand-washing with antibacterials will ward off disease are
most likely to get caught up in the vicious cycle, the experts
said.
“When I ask patients [with eczema] how often they
wash their hands, they say 20 to 25 times a day,” Baugh said.
“They think they are being good citizens by washing
frequently. But you can over do a good thing.”
Plus, the ease of pump dispensers is leading people to
wash more frequently, O’Donoghue said.
There’s no doubt the products are widespread: A recent
survey found that nearly half of 1,100 liquid and solid soaps
contain antibacterial agents.
From a dermatologist’s point of view, antibacterials are
among the most worrisome products contributing to skin
problems, O’Donoghue said. That’s because the same
detergent chemicals that kill bacteria wreak havoc with the
skin on the hands, Baugh explained.
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“They literally strip away fatty acids, moisture and
amino acid from the skin,” O’Donoghue said. “They
increase dryness, increase roughness and disturb the healthy
growth process.”
Overuse of antibacterials is worse than frequent use of
other soaps as chemicals in the detergents strip away the
naturally protective fats and oils on the skin, Baugh said.
“The fist thing to correct the condition is to remove the
offending product,” Baugh said. Yet patients are often
disappointed when told to use non-detergent products that
don’t eliminate the fat layers, he said.
Eczema can be treated with standard emollients that
replace oils in the hands, he added.
THE SUPERBUG DEBATE
Dr. Eli Perencevich, a research fellow in infectious
diseases at Beth Israel Deaconess Medical Center in
Boston, said he wishes people would skip the antibacterial
products altogether, pointing to lab studies that link them to
the emergence of superbugs.
“No one has ever been able to prove that using
antibacterial soaps meant that anyone was better off than
those using standard soap,” said Perencevich, who
performed the recent soap survey.
“However, there are [lab] studies that suggest use of
such products kill off the sensitive bacteria, leaving [behind]
hardier bacteria such as E. Coli and staphylococcus aureus,
which could be detrimental to health,” said Perencevich.
“The fear is that this process will result in bacteria that
live longer,” he said.
That fear may be misplaced, said industry
representatives.
“The rising incidence of antibiotic-resistant bacteria is a
serious worldwide concern,” said Dr. Jerry McEwen, vice
president for science at the Cosmetic, Toiletry and
Fragrance Association.
“There is no real-life evidence that antibacterial
products — as they are normally used in hospitals, in food
preparation and in people’s homes — contribute to
bacterial resistance.
“While some studies have shown that antibacterial
ingredients may promote resistant bacteria, these studies
have been done under controlled laboratory conditions that
do not reflect what happens to bacteria that consumers
encounter in the real world.”
While the debate
over antibacterials and
superbugs continues,
what is certain in the real
world, O’Donoghue
said, is that people who
use the products can end up with serious skin diseases that
need an expert’s help to correct.
Note: Vermont Soap does not support the use of Triclosan
and other antimicrobial agents for daily use. Soap kills germs. For extra
germ killing capacity we recommend our Tea Tree bar and liquid soaps, or the
more powerful Blue Bar. We also disagree with some of the dermatologists
who believe eczema and dermatitis are spread by bacteria. While there is a
bacteriological component, we believe that the culprit is often the
chemicals that we put onto our skin themselves. One hypothesis is that we
weaken and irritate our skin, kill off it's GOOD bacteria, and are then
susceptible to new infections......
Time and again our customers write us that their skin conditions cleared up
when they stopped using the common cosmetic chemicals. It took billions of
years for the Life Force to create people. Why do we contaminate ourselves,
our air, water, food and planet with new chemical combinations that did not
exist prior to this past century? Perhaps we will one day evolve to better
live with these chemicals, but we at Vermont Soap consider this a dangerous
and foolish course. Vote with your wallet! If consumers refuse to use the
people/planet threatening chemicals, companies will have to stop producing
them.
For Immediate Release: October 24, 2002
ANTIBACTERIAL SOAP NO BETTER THAN REGULAR SOAP,
NIH-FUNDED STUDY SHOWS
CHICAGO - Despite medical experts' doubts that antibacterial soap is a better
germ-killer than regular soap, half to two-thirds of hand cleansers on store
shelves are labeled as antibacterial. Now a National Institutes of Health (NIH)-funded
study confirms what medical experts have suspected. Results are being presented
here at the 40th Annual Meeting of the Infectious Diseases Society of America
(IDSA).
"It makes you wonder why they call it antibacterial, because according to our
research, it isn't any more so than plain soaps," said Elaine Larson, Ph.D.,
R.N., associate dean for research at the Columbia University School of Nursing,
New York, principal investigator of the study. "We found antimicrobial or antibacterial
soaps provide no added value over plain soap."
Further, some health care professionals are concerned that the ubiquitous use
of triclosan, the antibacterial agent most commonly found in such soaps, could
add to the growing problem of antibiotic resistance.
"There is no proof that antibacterial soaps can lead to resistance, but if there's
even a theoretical risk of that, why use it?" said Dr. Larson, who searches out
soaps that are not marketed as antibacterial for use in her own home.
The study was the first double-blinded, randomized controlled clinical trial
- the protocol considered most scientifically sound - to compare antimicrobial
soap to regular soap. The study involved primary caretakers in 222 New York
City households: half were randomly assigned to use antimicrobial soap for daily
hand washing and half were given non-antimicrobial hand soap. Microbe cultures
were taken after a single hand washing and following a year of washing with the
assigned soap. Neither the caretakers using the soap nor the investigators who
analyzed the cultures were aware who had been assigned regular vs. antibacterial
soap.
The two groups were assessed after one wash with the particular soap and after
one year of regular use of the assigned soap. Cultures showed that after a year,
there were fewer microbes on the caretakers' hands in each group, but there was
no difference between the groups.
Although the soaps are typically labeled antibacterial, they are actually antimicrobial,
meaning they affect viruses as well as bacteria, just as regular soaps do.
The study was funded by the National Institute of Nursing Research, a division
of the NIH.
Research suggests that the waterless alcohol-based antiseptics used by health
care workers in hospitals are the more effective germ killers.
The waterless antiseptics are not cleaning agents, however, as they don't remove
surface dirt, which is why hand-washing with regular soap is still the best approach
for regular daily hygiene.
"If you've got a newborn or a preschooler with a cold, you might consider using
an alcohol-based waterless product for a little extra protection against germs,"
said Dr. Larson. "But for daily hygiene, hand-washing with regular soap is fine.
Just be sure to wash all of the surfaces on your hands, the backs, between the
fingers, etc. It's not the amount of time that's important, but covering all
the surfaces, as well as applying friction."
The American Medical Association (AMA) recently noted that there was no evidence
that antibacterial products - including soaps, lotions and other household products
- work, whereas this study substantiates that they don't, said Dr. Larson.
Co-authors of a paper on the topic being presented at IDSA by Dr. Larson are
Allison Aiello, Susan Lin, Lillian V. Lee, D. James Kain and Phyllis Della-Latta.
IDSA is an organization of physicians, scientists and other health care professionals
dedicated to promoting human health through excellence in infectious diseases
research, education, prevention and patient care. Major programs of IDSA include
publication of two journals, The Journal of Infectious Diseases and Clinical
Infectious Diseases, an Annual Meeting, awards and fellowships, public policy
and advocacy, clinical affairs and other membership services. The Society, which
has nearly 7,000 members, was founded in 1963 and is headquartered in Alexandria,
Va.