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SHOULD YOU USE ANTIBACTERIAL CLEANSERS?

Ever wonder ‘whatever happened to good old fashioned soap’? Well it is still out there, but the question is does antibacterial soap work better? And should you be using this to protect yourself from germs? This is a question that has a 2 part answer: The first is for those who have normal skin, and second, for those who suffer from skin conditions such as eczema or recurrent folliculitis or other skin infections. There are many factors that should be considered when evaluating which kinds of soaps we should be using on our skin every day.

BACTERIA AND YOUR SKIN.

Many people do not know this, but your skin is always colonized by billions of bacteria, and that is actually normal. We are as a culture afraid of bacteria on our skin, but what we don’t realize is that we also harbor beneficial bacteria, this bacteria helps maintain a balance of good & bad bacteria, and even fungus. Just like you take probiotics for your gut and digestion, you have bacteria on your skin as well that serve a purpose. For well over a decade neonatal intensive care units have recognized this importance of skin flora, they have newborns and premature babies in skin to skin contact with their mothers, and have data to show that this increases rates of survival and reduces the rates of opportunistic infections. In comparison the babies that are kept under near sterile conditions had a higher risk of infections. In addition there are even topical medications that are being researched now on how to populate skin with healthy colonies of bacteria to improve skin conditions such bad as eczema and acne. So consider this before you buy a bar of soap that is antibacterial.

Antibacterial cleansers can have chemicals that are not particularly healthy to be used every day all over your skin. For example, the ingredient triclosan which has been shown to be a carcinogen and has been pulled by several companies. Most antibacterial cleansers can also be harsh on the skin and can be very drying, which is another reason I prefer to avoid their use.

SKIN CONDITIONS

The second answer to this question is for those who are suffering from a skin conditions such as acne, eczema or recurrent folliculitis, an there are other options that may be more helpful to control bacteria on the skin. For acne: a cleanser that contains salicylic acid or benzoyl peroxide may work very well. To treat moderate to severe eczema a dilute bleach bath (1/2 cup bleach to a full bath) once per week can be very helpful, or hibiclense if you prefer to wash in the shower. Folliculitis can also be controlled with a benzoyl peroxide containing wash.

However, to prevent the spread of germs & infections you should practice good hand hygiene, wash with soap and water when possible, and you can use a hand sanitizer when traveling or in public spaces. To sanitize your hands an alcohol based sanitizer will kill >99% of germs. For more sensitive skin alcohol free sanitizers are available for use on hands, and children’s toys and are non-toxic.

Spa treatments: Dr. P’s 5 tips for what you want, and what you don’t want to go home with.

Who doesn’t want to have a relaxing and refreshing Spa visit now and again to recharge your battery and feel pampered for a moment. It is important that we do indulge in these luxurious treatments for our skin and nails, but we must proceed with caution.

I recently was in a large shopping mall, and was quickly pulled in by a kiosk worker who started to buff my 1 fingernail before I could say yes or no to his administration. After I walked away, I was preoccupied with the thought that the very same emery board had been used on countless other people, and I could potentially develop a wart on that finger now! Sometimes the more you know, the worse off you are. However, this is just an example of how you can pick up a skin virus or infection without even knowing, and it is delayed often and will not present itself for weeks oftentimes. A similar incident once occurred during a massage when the masseuse began to use a cactus bristle brush against my skin as part of her routine, and the entire time I was concerned about the reuse of the tool, and was too polite to request that she not use it.

It may seem paranoid and I may be overthinking things, but this only comes to my attention because of what I see regularly in the practice of dermatology, I have many patients that have acquired warts from nail salons, the gym, and even from facials or waxing. Poor young women who have tiny warts disseminated over the face or body, and they will commonly have a history of frequenting a spa or salons. When you are using instruments on patients and not properly sterilizing them it can lead to the transmission of diseases, though not life threatening in the cases I have presented they are none the less difficult to treat and unpleasant.
Tips.

1. Seek out a salon or spa that uses a heat autoclave to sterilize their instruments.
You can ask directly if the instruments are autoclaved and they should be able to answer this question. Establishments that use autoclaves will often have their instruments in sealed bags. Other spas or salons will use an alcohol based solution to clean their instruments, this can be helpful, but is inferior to heat autoclaving. Autoclaving entails placing instruments inside a machine which under intense pressure and high heat destroys all organisms on tools and is the gold standard for sterilizing even medical and surgical instruments.

2. Don’t soak your feet in the foot bath in the nail salon.

Unless a disposable liner is being used for each customer, I cannot think of a dirtier place to soak your feet, as appealing as a nice warm soak might sound…I have seen some terrible infections that were picked up at nail salons. One such customer had suffered an amputation of one of her toes due to a salon acquired infection. The issue is that you never know who is going to pick up an infection. The vast majority of people who have these services have no such serious complication, but very commonly will develop a wart or athletes foot.

3. Bring your own nail filers/emery boards, and/or other nail tools if you desire.
When in doubt, you cannot go wrong by being prepared and bringing in your own supplies. You may get a few looks by other customers, and cause the employees to talk a little, but is it worth it to have fewer worries about your health, absolutely! It is not uncommon for many salon goers these days to come prepared with their own trusted equipment.

4. Do not permit the use of any reusable instruments that are not sterilized.
For example: getting a massage and being scrubbed with a brush that is used on other customers. Do not be shy, and don’t let anyone use something that has not been properly sterilized. A nice way of avoiding this awkward moment is to actually be up front and direct with your question before having a service.

5. If you do pick up what appears to be a wart, nail fungus, or another skin infection, do not delay seeking dermatological care, the earlier you start treating the easier it is to fully resolve.

There are so many great treatments to treat warts, and skin or nail fungus, that it makes no sense to waste time before getting treated. In additions, holding off treatment can result in the development of more warts and spreading warts or fungus to your loved ones at home.