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Antibacterial soap overuse may help spread disease.

ANAHEIM, Calif., Aug. 1, 2000

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.

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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.

“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.

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