ELSEVIER

The Effects of Detergents on

Hydration and Skin Surface Lipids
PER THUNE, MD

W
e all know that frequent use of soaps and influencing the hygroscopicity and water-holding ca-
synthetic detergents to cleanse the skin may pacity as well as the barrier function.5-7 Increases in
lead to a dry, chappy appearance and even to TEWL values as a result of a defective water barrier and
toxic reactions and eczema. We also know that there are reservoir function are associated with less hydration
individual differences in susceptibility and that various and water-holding capacity of the skin8 It has been
products are less well tolerated than others. assumed that the ability to take in water-that is, hy-
The barrier function of the stratum corneum is cru- groscopicity-is more dependent on natural moisturiz-
cial in protecting the skin against environmental influ- ing factor (NMF) components, which are hygroscopic
ences, including the use of detergents. In cases with substances of small molecular weight, while water re-
defective barrier function, transepidermal water loss tention requires a stratum corneum with an intact struc-
(TEWL) values increase, and the skin becomes drier ture.7 In one investigation the extraction of amino acids
with less water content. Water is the only plasticizer for by water did not affect the hydration status of the stra-
the stratum corneum, influencing the appearance, tum corneum sheet.’ It was assumed that amino acids
suppleness, and pliability of the skin. If the water con- are important for the suppleness of the skin and that
tent in the uppermost layers of the horny layer is less keratin fibers themselves are primarily involved in the
than lo%, the skin appears dry and chappy with fine water-holding capacity.
scales and feels rough to the touch. The stratum cor-
neum receives water from within but may also take Investigations
water from the environment, which is the basis for the
effect of hydrating or moisturizing agents. During the past 10 to 15 years, there have been several
The water content of the outer layers of the stratum reports on the effect of soaps and synthetic detergents
corneum fluctuates with the environmental humidity on the skin. Almost 15 years ago, Hassing et al. showed
level. Clinically occurring dry skin is actually a hetero- that measurements of skin vapor loss appear to be a
geneous group because we can distinguish between reliable method for assessing the damaging effect of
physiologically dry skin with a normal water content as low concentrations of soap.” They observed marked
seen in a dry environment and real dry skin with an effects by means of this method before morphologic
abnormal low water content due to structural and bio- changes in the epidermis could be visualized. They also
chemical abnormalities in the stratum corneum. questioned the widely held opinion that alkaline solu-
Characteristically, the “dry skin syndrome” is accen- tions of soap were prone to damage the skin. In fact,
tuated during the winter months in the presence of acid soaps initiated a marked increase in vapor loss.
cold, wind, and low humidity. It is also typical that The studies were performed on the volar side of the
aged skin has a lower water content than younger skin forearm. But one should keep in mind that there are
because it is thinner’ and perhaps also because it con- great differences in reactivity, amount of sebaceous lip-
tains fewer ceramides.’ So-called dry noneczematous ids, and skin thickness (stratum corneum) between
skin in people with atopic dermatitis contains less water various skin sites. Accordingly, it is impossible to com-
than normal-appearing skin and that of controls (Fig pare measurements of casual lipids performed on the
1).3 It also frequently feels rough to the touch. The cause face with a sebumeter with measurements of skin lipids
is probably a disorder of cornification and lack of cer- from the stratum corneum or to compare various TEWL
tain skin lipids.’ values from different skin areas. It may well be that a
The skin surface lipids consist of a mixture of sebum superfatted soap is preferred by people with “real” dry
and lipids derived from the stratum corneum. The stra- skin-atopics and elderly people, for example-but the
tum corneum lipids are produced by the keratinocytes4 effect might be other than that on the sebaceous lipids.”
and are of paramount importance as water modulators About 10 years ago, Fulmer and Kramer used a com-
mon surfactant, sodium dodecyl sulfate, to induce dry,
scaly conditions in human subjects.” These were
From the Department of Dermatology, Ulleuaa”l Hospital, Oslo, Norway.
Address correspondence to Per Thune, Professor M.D., Department of treated daily over a period of 2 weeks on one lower leg.
Dermatology, UIlevadl Hospital, 0407 Oslo, Norway. The contralateral leg was left untreated. The treatment

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resulted in lower stratum corneum hydration and in- 120
1
creased surface scale and roughness. Excised skin from
the treated leg showed significant changes in stratum
corneum lipids with regard to the specific lipid classes
(ceramides), although the total quantities did not
change. The findings were interpreted in terms of per-
turbated stratum corneum formation and maturation-
that is, keratinization-rather than gross lipid extrac-
tion. group 1i group 2:
Froebe et al. measured the type and amount of lipid
l
extracted by two anionic surfactants known to be highly
irritant to skin.13 Very small amounts of lipids were
removed from the stratum corneum. They questioned .2 3 4 .5 6 7 8 0
the long-held belief that surfactants damage the skin by mgl+O/mgd.l
removing sizable quantities of lipids and speculated
that surfactant-protein and not only surfactant-lipid in- Figure 1. Measurements with the CM 430 corneometet
teractions were at work in the production of erythema. (hydration) correlated to the absolute amount of water within ihc
stratum corneum in vitro (mg H,O/mg dry tissue). Group 2:
As a matter of fact, it appeared that skin protein was the atopic dermatitis-dy skin. Group 2: atoprc dermatitis-normal
major site of surfactant binding. skin. (Reprinted with permission.)
The stratum corneum lipids are supposed to be ar-
ranged in an extracellular membrane network of mul- link between xerosis of the leg and the decline of the
tiple bilayers embedding the protein-enriched corneo- sebaceous function” has been reported.”
cytes. i4 If the surfactants bind to a small amount of The hydration data obtained in old, dry-appearing
stratum corneum lipid, they may impair the function ot skin were compared with those seen in old and young
the membrane and alter the interlayer spacing of the control subjects and with those from unaffected skin in
bilayer and damage the lipid structure, as mentioned by atopics. I8 The only sig nificant difference observed wilh
Froebe et alI3 The same authors also speculate that the that the atopic subjects had a lower hydration state than
feeling of “dryness” roughness, tightness, and scaling all the other groups. Water sorption-desorption tests
that is elicited by surfactants can be due primarily to demonstrated a lower prehydration state in atopic skin
keratin binding in addition to the lipid membrane per- and a lower hygroscopicity and water-holding capacity,
turbation.
Clinical dryness of the skin is a common problem Figure 2. Measurements of hydration. The shaded area indicate,
among elderly dermatologic patients. In one study, hy- the 95% conj+denccarea for the younger control group (n = 2.?!
dration and skin surface lipids (of sebaceous origin) Vertical range bars indicate the 95% confidence interval of the
median ualues in the dry-skin group (n = 40). f0 alkaline soap,
were studied together with the TEWL.15 A comparison l sebamed.)
of local effects of acid and alkaline cleansing products
was made. One arm was washed with an alkaline soap,
while the other arm was washed with an acid detergent,
followed by application of an acid lotion. After 1 weeks es- HYDRlsKmUmTS
topical therapy, the hydration values increased on both
sides (Fig 2). At the same time, the TEWL values de-
creased. The skin surface lipid readings showed a sig-
nificant increase on the side treated with acid products
but not on the other side (Fig 3). The increase in surface
lipids might have reflected the presence of compounds
that were derived from the lotion itself, but it could also
have been due to a modification of the NMF compo-
nents and epidermal lipids, manifested as an increase in
the stratum corneum hydration. No deleterious effects
were observed. Corresponding changes in TEWL and
hydration were observed on both sides-that is, also the
one treated with an alkaline soap. This indicates that
water was the main factor responsible and concurs with
other opinions regarding the minor importance of skin
surface lipids of sebaceous origin,i6 although “a close
Clinics in Dermatology l 1996;14:29-33
sari Anuomwak
oftmebnmt
Figure 3. Measurements of the skin lipids. (Symbols are as in
Fig 2.)
Control skin and old, dry skin did not differ. In another
study, Berardesca et al., using analogous equipment,
showed a reduced water content and increased TEWL
in atopics who were free from all signs of skin disease,
compared to sex- and age-matched controls and psori-
atics. Also, the water retention capacity, as measured by
the plastic occlusion stress test, was significantly lower
in atopics.”
Abnormal hygroscopicity and water-retaining capac-
ity have been demonstrated in xerotic skin of the
legs, 1,2,20,21
while other studies on the arms have shown
normal skin conductance. 15,i8 The discrepancies are
probably due to different sensitivities of the methods
applied and the variation in skin sites examined. For
instance, one study described no change in stratum cor-
neum lipids in elderly, xerotic skin compared with the
data obtained in younger persons,l’ whereas other in-
vestigators have reported a decline and relative change
in composition in stratum corneum ceramides with in-
creasing age.21,22 A decreasing activity of the ceramide-
producing enz me sphingomyelinase has also been
demonstrated? Y
Wilhelm et al. showed that anionic surfactants can
increase stratum corneum hydration in vivo.24 The in-
duction of hydration was closely correlated with the
irritation potential of the investigated compounds. The
maximum effect was obtained for sodium lauryl sulfate
(SLS). It is interesting to note that the same authors also
indicated that the initial SLSinduced increase in stra-
tum corneum water content was reversed to a dramatic
drying several days after exposure. They speculated
whether the initial statum corneum hyperhidrosis and
subsequent dryness could be a result of the same
DETERGENT EFFECTS ON HYDRATION AND LIPIDS 31
mechanism but at different observation times. The ex-
cess water uptake was related to a conformational
change of stratum corneum keratin proteins in the pres-
ence of the alkyl sulfate. After evaporation, it is con-
ceivable that the tertiary structure of the protein cannot
be totally restored but is left with some functional de-
fects. The ensuing reduction in water-binding capacity
after repeated applications of SLS is accordingly due to
a denaturation of keratin protein.
A low quantity of ceramides has been demonstrated
in atopic skin,2 in addition to small corneocytes25 and
abnormal lamellar bodies.26 These are findings that can
certainly be related to the low water content and the
appearance of rough, dry skin, which is more than nor-
mally vulnerable to the effect of various surfactants.
This also implies an abnormal cohesion of the cells.
Yamamura and Tezuka investigated the water-
holding capacity of the stratum corneum in the hairless
rat by means of nuclear magnetic resonance.*’ The
bound water content remained unchanged by the ace-
ton-ether extraction treatment. This also means that wa-
ter-soluble components like NMF as amino acids and
pyrrolidone-carboxylate help to enhance the bound wa-
ter content. Lipid analysis showed that chloroform-
methanol extraction consisted of polar lipids like sphin-
gomyelin in addition to a large amount of free amino
acids. Aceton-ether extraction consisted of nonpolar lip-
ids such as sebaceous gland lipids and a small amount
of polar lipids such as ceramides. It is probable that the
NMF components are ionized in the water in intercel-
lular spaces and form complexes with the lipids, which
are then arranged in a lamellar structure.27
Application of aceton-ether to the human forearm for
extremely long periods showed that sebaceous lipids
were extracted for the first 10 minutes, followed by ex-
traction of stratum corneum lipids during the next 20
minutes.28 Application of sebaceous lipids on deli-
pidized skin did not alter the induced defect in water-
holding properties, while application of a ceramide
fraction on delipidized skin induced a recovery in wa-
ter-holding properties.
Also, Berardesca et al. investigated the effects of de-
lipidization on the water-holding capacity of the stra-
tum corneum using the plastic occlusion stress test pro-
cedure.30 They observed a sig nificant effect of
chloroform-methanol treatment versus ether-aceton
and concluded that polar lipids have a profound role in
modulating the barrier function and water-holding
properties of the stratum corneum.
Conclusions
The water content of the stratum corneum has been
estimated at approximately 30% by weight. About 10%
of this is lipid associated, while the remaining 20% is
resistant to solvents and water extraction and is attrib-
uted to keratin components.2
32 THIJNE.
The skin of the legs and forearms has been the site of
many investigations, because it has a tendency to de-
velop signs of xerosis with cracking of the horny layer,
desquamation, and a feeling of roughness and dryness.
In addition, sebaceous glands are sparse, particularly
on the legs.
Several factors may influence the measurement of
stratum corneum lipids. With aging, the turnover rate
of the epidermal cells is prolonged, there is a decline in
epidermal proliferative activity, and the number of stra-
tum granulosum cells decreases. The biosynthesis of
sphingolipids is influenced by epidermal proliferation,
and changes in sphingolipid composition may reflect a
decline in the sphingomyelinase activity with aging.“’
The ceramides have been supposed to play a crucial
role in water barrier function and perhaps also in the
water-holding capacity of the stratum corneum.“,‘”
Menon et al. demonstrated a “clear dynamic relation-
ship between the host’s water-barrier requirements and
epidermal sterol metabolism.“2” They showed that
damage to the barrier with either detergents or solvents
resulted in a burst of lipid synthetic activity in the epi-
dermis, The time course of this activity paralleled bar-
rier repair. The lipid synthesis could be partly blocked
by the application of a membrane impermeable to water
vapor that imitated fully restored stratum corneum bar-
rier function. The regulatory factors and second mes-
sengers at work in the repair process are only partly
known. According to Elias, the lipid biosynthetic re-
sponse to barrier disruption is “differentially regulated
in the lower nucleated (basal/spinous) versus outer
nucleated (granular) cell layers of the epidermis.““
Also, DNA synthesis is regulated by barrier require-
ments.”
It was assumed until recently that the ceramides
were of paramount importance for the water-holding
capacity of the stratum corneum and for barrier func-
tion.2,27b8 This was shown with of extraction methods
by which the skin was delipidized and also by local
application of ceramides on delipidized skin--in which
case, the barrier can be restored.
Recent investigations performed with surfactants
such as SDS and SLS indicate no gross lipid extraction
if the application time is not extremely prolonged, but
there is a change in ceramide biosynthesis.i2,‘” At the
same time, the cholesterol and free fatty acid profile is
altered. These findings are interpreted as SDS alter-
ations in the keratinization process, while total sterol
levels remain unchanged. Alterations in quality of stra-
tum corneum lipids result in a defective lipid matrix,
which may lead secondarily to a disturbed comification
process.
The role of the sebaceous lipids in dry skin has been
much debated.16 In fact, there has been no correlation
between sebaceous gland activity and the presence or
severity of dry skin or hydrationa’-“”
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