Antibacterial Soap

Are you one of those folks who is creeped out by the idea of bacteria on your skin?  Do you like the idea of sterile bathrooms and kitchen counters?  Do bacteria and viruses always equal illness in your world?

This week I would like to encourage you to think of the bacteria on your skin in a different way.  Most of the bacteria on and in our bodies are safe and actually helpful for us.  In fact, they provide a barrier and competition for harmful bacteria so they have a harder time getting a foothold on and in our bodies.

Infection and symptoms of illness are often related to a harmful species of bacteria or virus either getting into a part of the body where they don’t belong (like E. coli from the colon finding their way to the bladder and causing a urinary tract infection) or overgrowing and out-competing harmless bacteria.

Do you know anyone who has had MRSA boils on their skin?  This is often a problem with sports teams that wear pads (like football, soccer and hockey) or where shared equipment can spread infection (like wrestling or martial arts where mats can’t be completely sterilized).

Often athletes that compete in these sports are encouraged to not only clean their equipment as thoroughly as possible but to use antibacterial soap to wash their skin.  The idea is to use antibacterial soaps to kill the bacteria that cause infection.

The problem is that they don’t work.  There is no evidence that soaps that contain antibacterial products do anything to reduce infection rates.  They are no better than plain soap and water.

In fact the FDA just issued a ruling that certain antibacterial products (like those containing triclosan and triclocarban) cannot be marketed anymore.  Manufacturers have a year to remove the bactericidal ingredients from their products.

If it was just that antibacterial substances didn’t work to reduce infection, I don’t think the FDA would have issued the ban.  But these substances may actually be harmful.  For instance, triclosan has been shown to increase the rates of Staphylococcus aureus bacterial colonization in the nose.

When I have a patient who has recurrent boils or a culture that’s positive for MRSA, I make sure to tell them NOT to use antibacterial soaps.  Most patients (and parents, as a lot of these patients are teenage athletes) look at me like I’ve suddenly sprouted a second head.  They’ve been scrubbing themselves with antibacterial soaps like there’s no tomorrow (and bleaching everything in sight to boot) trying to get rid of the germ.

I take a step back and try to get them to consider their skin as a patch of soil in the garden.  There are plants that are very invasive and fast-growing, and there are plants that are a bit more delicate.  MRSA and other staph bacteria are fast-growing and invasive, and the healthy bacteria are a little slower.

If you take your garden and hose it down with weed-killer, it kills your pretty, delicate wildflowers faster than the tough, invasive species, leaving the stronger ones with no competition.  It’s better to avoid the weed-killer and plant lots of wildflowers while just pulling out the ones you don’t want.

In the case of recurrent boils and staph infections, we use oral antibiotics (which don’t disturb the bacteria on the surface of the skin) to kill the bacteria down in the hair follicles and mupirocin ointment in the nose to kill staph where they tend to hide.  It’s true that the oral antibiotics disrupt the bacteria in the gut but it’s temporary and using oral probiotics helps reduce the damage.

It’s estimated that there are 10 bacterial organisms on and in your body for every cell that is actually “you.”  90% of the person we see walking around is actually one big bacterial colony.  On your skin, in your nose and mouth, in your GI tract and, in the case of women, in the vagina.  The vast majority of those bacteria are harmless, helpful symbionts that stimulate our immune system to be healthy, give us vitamins and other helpful substances that we’re just beginning to understand, and help protect us from harmful invading bacteria.

The healthy, helpful bacteria on and in your body are PART of your body and belong there.  Please try not to think of them as invaders or as dangerous.  Help them help you, and your body will be healthier.

QUESTION: Do you use antibacterial soaps? What do you think of the FDA’s ruling?