Personal Cleaning / Prevention

Soap and water best for reducing skin infections

By B.J. Anderson, M.D.

Americans spend an exorbitant amount of money to maintain “cleanliness” in an attempt to reduce infections. In 2009, $7.3 billion was spent in the US on cleaning products with $2.4 billion on soaps and over $900 million on antibacterial chemicals. In athletes, especially those in close skin contact with teammates and opponents, infections from Methicillin-resistant Staphylococcus aureus (MRSA) and Ringworm (also called Tinea Corporis) are quite common. Whether from direct skin-to-skin contact, equipment, or mat surfaces the risk of acquiring a skin infection is a known and real. So it is important to keep skin and contact surfaces as clean as possible to reduce transmission. But at what cost?

MRSA bacteria has blossomed, although not in a good way, over the past 15 years to be the single most prevalent cause of skin related abscesses (boils). Primarily affecting youth and young adults, it is often thought to be a ‘spider bite’ that progresses to a simple boil. Treatment with incision and drainage (lancing) is usually adequate, but occasionally antibiotics are necessary. The problem lies in reoccurrence of the infection. Once an individual has an outbreak, there is a 50% chance of reoccurrence over the next year. Simple hygienic principles like washing with soap and water or using cleansing agents can reduce this risk of repeated MRSA infection.

Ringworm, the other common skin infection, is caused by dermatophyte, T. tonsurans and can affect up to 70% of high school wrestlers each season. This fungal infection spreads by direct contact with the skin of an infected individual or contaminated surface. Ringworm is extremely contagious and can spread easily and rapidly throughout a wrestling team. The fungal infection is superficial, but can be a nuisance for athletes like wrestlers who must pass skin inspections on a near daily basis to practice and compete. Treatment with topical antifungal creams are generally effective, but occasionally oral medications are required. The treatment may take up to 6 weeks to fully eradicate the fungus. Ringworm is a huge issue for wrestlers it often takes daily skin checks, along with meticulous skin hygiene to reduce and control this skin condition.

Antibacterial soaps, washes and wipes contain a wide array of substances purported to reduce the bacterial/fungal counts and reduce skin infections in the athletic setting. Triclosan and triclocarban are two agents that have been used extensively in consumer antibacterial products like soaps, toothpaste, mouthwash and deodorants. There are other less known ingredients that have also been used, such as tea tree oil, isopropyl alcohol, and triethanolamine. While these agents have been in use for decades and have been heavily promoted as beneficial, most of the literature on their effectiveness is based on anecdote and not scientific evidence. Although some have been shown to be useful as antimicrobials in the hospital setting, the efficacy in out of hospital settings is not proven. Although laboratory data showing reduced bacterial/fungal growth on a petri dish is reproducible, the extrapolation to reducing microbial growth on the athletes’ skin is implied, but not proven.

In September 2016, the FDA released a new ruling on the Safety and Effectiveness of Consumer Antiseptic topical products - soaps, washes, and wipes. isopropyl alcohol hand sanitizers were excluded since their use for hand sanitation has been proven, but the body wipes which are unproven, were included in the ruling. The FDA could find little data showing effectiveness of any of these products compared to the use of soap and water in reducing the risk of skin infections and have required that manufacturers of these products withdraw any statements of product effectiveness until efficacy studies have been performed to confirm effectiveness. The products must be more effective than simple soap and water in reducing skin infections in users for manufacturers to make claims about anti-microbial effectiveness. With the vast number of these products and annual public expenditure, showing product efficacy with scientific study seems a reasonable requirement as most of these products are extremely expensive compared to soap and water.

In 2010, a study comparing an isopropyl alcohol body wipe to a soap and water wipe in wrestlers over the course of one high school season was performed in Minnesota. The results showed the soap and water wipes were slightly better and statistically just as efficacious. With the cost of the isopropyl alcohol wipes at 10-15 times that of the soap and water wipe, it makes financial sense to use the soap and water wipe.

Another issue is the environmental and personal safety impact of repeatedly using these chemicals on the body and disposing of the waste. Recent studies focusing on the use of triclosan and triclocarban have found cumulative absorption into the body, and these chemicals may have effects on hormone regulation and receptors. Also recent studies have found these chemicals do not breakdown and accumulate in our waterways and sewage, which contributes to bacterial resistance and potential problems for antibiotic development. In response to these research findings, the State of Minnesota banned these agents from consumer hygienic products in 2014.The annual expenditure in our athletes to reduce skin infection with unproven products is huge. Until the manufacturers can show effectiveness in these antibacterial soaps, washes and wipes it appears we should be using plain soap and water immediately after practice to keep our athletes infection free.

Originally published in MSHSL Bulletin, Winter 2017