Joshua Zeichner, MD: Let’s switch gears and talk about cleaners. We talk about everything like soap, but the reality is that traditional soaps have an alkaline pH and disrupt the skin barrier. The latest generation of cleansers are soap-free products, and these different technologies are perhaps more balanced to the pH of the skin, gentler on the skin barrier, and associated with different levels of irritation. Mona, explain to us this painting we see.
Mona Gohara, MD: Lipid-free cleansers are mostly made of water and glycerin. These are the 2 main ingredients, which are very hydrating. Primarily, these will have low rates of skin irritation and can help the skin barrier. That’s what we’re talking about, because they can lessen the irritation that patients may experience from retinoids and benzoyl peroxides. You cleverly pointed out that soaps have a high pH and don’t match our skin’s normal acid mantle and can be extremely irritating and strip the barrier causing more irritation. In the treatment of acne, we avoid soaps. I use soaps on my dishes, not on my face. I want the oils on my dishes to go away, but not on my face with this high volume.
Joshua Zeichner, MD: The purpose of cleansing is to remove dirt, oil and other soils from the skin without compromising the skin barrier.
Mona Gohara, MD: The problem is that there is this barrier compromise because the barrier likes to operate at this pH of 5.5 to 7, so there is a minor conflict. Combars are a combination of fatty acids and synthetic detergent. If synthetic soaps and detergents had a baby, they would be fights. I tend to avoid them as their pH is a bit higher in acne. Then synthetic detergents lower the pH to where the acid mantle likes to be, and our epidermis likes to be healthy. If we land in 2 places, we should recommend cleansers that will support the epidermal barrier. I’m going to make the changes that we saw in the previous 2 slides on benefits for the condition and benefits for how patients feel about themselves. In skin, we stick to lipid-free cleansers and syndets.
Joshua Zeichner, MD: Most of you listening to this are probably already recommending synthetic detergents without even realizing it. These are the cleansing bars or products that may say moisturizing, but they don’t use the word soap necessarily. For people who are a little more sensitive, these are lipid-free cleansers. You already recommend, and you may not even realize it. These are extremely hydrating and tend to leave a hydrating film on the skin. They are suitable for all skin types, especially sensitive people.
Transcript edited for clarity