Received: 10 January 2018 | Revised: 11 June 2018 | Accepted: 17 July 2018

DOI: 10.1111/jocd.12758

ORIGINAL CONTRIBUTION

Effects of four soaps on skin trans‐epidermal water loss and

erythema index

Zeynab Khosrowpour PharmD1 | Saman Ahmad Nasrollahi PharmD , PhD2 |

2 2 2
Azin Ayatollahi MD | Aniseh Samadi MD | Alireza Firooz MD

1
Department of Clinical Pharmacy, Faculty
of Pharmacy, Pharmaceutical Sciences
Branch, Islamic Azad University, Tehran,
Iran
2 of soaps/cleansers.
Pharmaceutical, Cosmeceutical and
Hygienic Evaluation Lab, Center for
Research & Training in Skin Diseases &
Leprosy, Tehran University of Medical
Sciences, Tehran, Iran
Correspondence
Alireza Firooz, Center for Research &
Training in Skin Diseases & Leprosy, Tehran
University of Medical Sciences, Tehran, Iran.
Email: firozali@tums.ac.ir
Summary
Background: Various tests have been carried out to determine the irritant potential
Objectives: This study was carried out to compare the effects of four different soap
formulations on biophysical parameters of the skin, including trans‐epidermal water
loss (TEWL) and erythema index.
Methods: Four different soap formulations (creamy, glycerin containing, syndet, and
traditional alkaline soaps) were studied. Twenty healthy volunteers were enrolled and
8% solutions (W/V) of the soaps made with distilled water, 20% sodium dodecyl sulfate
(positive control) and water (negative control) were applied to their volar forearms as a
single dose patch test. The patches remained on the sites for 4 hours. The skin TEWL
and erythema index were measured before applying the patches and 24 and 72 hours
after removal of them using TEWAmeter and Mexameter probes, respectively.
Results: Alkaline and creamy soaps caused a significant increase in TEWL 24 hours
after patch removal. However, 72 hours after patch removal, this increase was sig-
nificant only in case of alkaline soap (P‐value = 0.002). A decreasing trend in skin
erythema was observed 24 and 72 hours after application of syndent, glycerin, and
creamy soaps. In case of creamy soap, this decrease was significant 72 hours after
patch removal (P‐value = 0.006).
Conclusion: Traditional alkaline soap increased TEWL and skin erythema, which are
signs of prolonged damage to the skin barrier. However, the effects of other formu-
lations were transient, and TEWL returned to baseline at 72 hours. Creamy soap
even showed a relative protective effect (decrease in erythema index compared to
baseline), probably due to the lanolin content of the formulation.

KEYWORDS
patch test, skin irritation, soaps

1 | INTRODUCTION quite frequently can cause dryness and irritation of the skin.1,2
Traditional soaps are often highly alkaline with an anionic surfac-
Soap is probably the oldest skin cleanser. Soap is obtained from
tant and therefore inexpensive. Often in these soaps, natural oils
the saponification of oils and fats by alkali from many years ago. It
like tallow and coconut oil are used and final pH is between 9
is the prototype anionic surfactant used in skin cleansers and plays
and 10.3
a prominent role in the personal cleansing market. However, soap

J Cosmet Dermatol. 2018;1–5. wileyonlinelibrary.com/journal/jocd © 2018 Wiley Periodicals, Inc. | 1

2 | KHOSROWPOUR ET AL.

Glycerin soap is a kind of moisturizing soap. It contains humec-
tant—glycerin—to counter the drying effects of soap. The unique
quality of this soap allows it to be used for different types of skin.
Glycerin soap can be used for the most sensitive skin, such as
eczema or psoriasis.4,5
Creamy soap has the same base of alkaline soaps and is mostly
alkaline. A series of self‐emulsion compounds (emollients) are added
to these soaps to reduce the damage caused by alkaline soaps. These
ingredients reduce trans‐epidermal water loss (TEWL) and increase
the amount of water present in the horny layer of the skin.4–7
The word “syndet” is derived from “synthetic” and “detergent.”
Often the term “soap free” or “soap without soap” is used for syn-
det. Syndets have a nonsoap synthetic surfactant such as fatty acid
isothiocyanates, sulfosuccinic acid esters as their principal ingredient,
and they have a different formulation and chemistry than traditional
soap based on natural oils. These synthetic surfactants make syndet
the most neutral person cleaning soap, have a neutral or slightly
acidic pH and are less irritating to skin. The relatively high free fatty
acid content of synthetic detergent bars provides a moisturizing ben-
efit that helps to maintain skin hydration.1,4,8
Soaps and most surfactants cause irritant skin reactions. For this
reason, the effects of surfactants on the skin have been extensively
studied under in vitro and in vivo conditions.9,10 It was shown that
skin cleansers induced biochemical changes in the skin when applied
topically.11 After the introduction of the soap chamber test by
Frosch and Kingman in 1979, many other tests were considered to
evaluate the irritation potential of various soaps. It is proposed that
a 4‐hour patch test represents a direct method for assessment of
the skin irritation potential of detergent formulations like soaps.
The aim of this study was to compare the effects of four soaps
in Iran’s market on skin trans‐epidermal water loss (TEWL) and ery-
thema index after 4‐hours patch test.
2 | METHODS
2.1 | Setting
This study was carried out in the Pharmaceutical, Cosmeceutical and
Hygienic Evaluation Lab (DermaLab) of Centre for Research and
Training in Skin Diseases and Leprosy, Tehran University of Medical
Sciences (TUMS).
2.2 | Subjects
In this pilot study, 20 healthy volunteers, between the age of 18 and
50 years, without past or present history of skin diseases were
enrolled. They had healthy forearm skin and should have not used
antihistamines and oral corticosteroids in the week before the start
of the study. The participants accepted not to use cosmetics and
any other topical agents in test sites 7 days before the start and dur-
ing the study.
Individuals were excluded if they were pregnant, lactating, cur-
rently receiving any systemic or topical medications, had a heavy hair
density on their arms, had any soap allergy history or had a past his-
tory of acne, eczema and psoriasis.
Participants were not allowed to wash their test sites within
attaching and after removing the patches for 72 hours. The study
was performed during the summer time (July to September 2016).
Written informed consent was obtained from all participants and the
study protocol was reviewed and approved by the Ethics Committee
of TUMS (acceptance code: IR.TUMS.VCR.REC1395.625).
2.3 | Products
Four commercially available soap bars were used in this study. The
products were traditional alkaline soap bar, glycerin soap bar, creamy
soap bar, and syndet bar (Table 1).
2.4 | Patch test procedures
All bar soaps were chopped down. About 8% solution (W/V) of the
soaps was made in distilled water. We used 20% sodium dodecyl
sulfate (SDS) as a positive control and distilled water as a negative
control. SDS (20%) is a model irritant that gives rational, but not
extreme, levels of irritation. Approximately 30 µL of each four soap
solutions and two controls were applied on Finn chambers (Smart-
practice, Phoenix, AZ) with a micropipette, and the patches were
sealed for 4 hours on right forearm of volunteers.

T A B L E 1 Characteristics of four commercially available soap bars

Soap type Ingredients pH pH analysis method
Syndet Sodium cocoyl isethionate, disodium lauryl sulfosuccinate, cetearyl alcohol, 5.5 The pH of 8% aqueous solutions of all soaps was
stearic acid, glycerin, zea mays (corn starch), hydrogenated castor oil, measured by 827 pH laboratory, Metrohm AG,
sodium trideceth sulfate, cocamide MEA, paraffin liquid, cocamidopropyl Swiss.
betaine, almond oil, jojoba oil, bicarbonate sodium, deionized water
Glycerin Sodium palmitate, sodium palm kernelate, propylene glycol, sodium palm 10.13
soap kernel acid, glycerin, fragrance, color
Creamy Tallow, coconut fatty acid, sodium hydroxide, lanolin, EDTA, fragrance, 10.27
soap color, and preservatives
Traditional Sodium tallowate/sodium palmate, sodium cocoate/sodium palm 10.48
alkaline kernelate, TiO2, magnesium sulfate 7H2O, sodium silicate, paraffin,
soap EDTA, color, fragrance, and water
KHOSROWPOUR ET AL.
2.5 | Measurements
Skin erythema and TEWL were measured before the intervention
(baseline), 24 and 72 hours after removing the patches. The room
temperature was set to 19‐21°C and the humidity level between
35% and 50 %. All the measurements were taken using probes of
TEWAmeter TM 300 and Mexameter MX 18 (Courage & Khazaka
electronic GmbH, Cologne, Germany).
TEWAmeter probe measures the density gradient of the water
evaporation from the skin. It has two pairs of sensors (temperature
and relative humidity). A microprocessor analyses the values and
−1 −2
express the evaporation rate in g h m . For the Mexameter
probe, the measurement is based on absorption/reflection. Specific
wavelengths are used for measuring the erythema index by corre-
sponding them to the spectral absorption peak of hemoglobin. The
experimental procedure is summarized in Figure 1.
2.6 | Statistical analysis
Statistical analysis was carried out using SPSS (Version 18.0; Interna-
tional Business Machines crop (IBM), North Castle, NY, USA). Descrip-
tive statistics (mean, standard deviation, and percentages) were
performed and statistical differences were tested between the differ-
ent visits, using Paired‐Sample T Test. Significance was set as P < 0.01.
3 | RESULTS
Twenty volunteers (4 males, 16 females) participated in this study.
The age of the volunteers ranged between 18 and 50 (mean age of
34.5 ± 8.66) years. The site of positive control (20% SDS) demon-
strated varying degrees of erythema. There were no sores at the site
of application of positive control, although induration was observed
in one volunteer.
As depicted in Figure 2, generally there was an increase in TEWL
in all soaps. Twenty‐four hours after removing the patch, traditional
alkaline soap and creamy soap showed significant increase in TEWL
from 10.35 ± 5.03 to 13.30 ± 3.90 g h−1 m−2 (P‐value = 0.001) and
from 10.93 ± 1.79 to 13.66 ± 3.27 g h−1 m−2 (P‐value = 0.0009),
respectively. After 72 hours, the TEWL of the traditional alkaline
soap still remained significantly higher (14.58 ± 5.25) than the base-
line (P‐value = 0.002).
Exposure 4 hr.
Times (h)
Initial
measurement
TEWL, Erythema
FIGURE 1 Experimental procedure. Measurement schedule of erythema and TEWL after single exposure to soaps
| 3
No significant changes in the erythema index were observed
after 24 hours in any of four soaps (Figure 3). After 72 hours, there
was only significant reduction in erythema from 218.34 ± 74.29 to
184.01 ± 57.11 in creamy soap (P‐value = 0.006).
4 | DISCUSSION
This study we showed that four different soaps caused an increase
in TEWL 24 hours after a 4‐hour patch test model, which was statis-
tically significant for traditional alkaline and creamy soaps compared
to the baseline, which is an indication of acute injury to the epider-
mal barrier. The human 4‐hour patch test provides a novel method
for the testing of acutely irritating chemicals in human volunteers.12
The validity of this method for chemical irritancy prediction, as well
as its adherence to high ethical standards, has been described by
Robinson et al. in 2001.13 Various parameters (visual aspects and
skin biophysical indexes) have been used to evaluate the irritation
level of cleansers on the skin. Among them, TEWL and erythema are
mostly used.14
TEWL has played an important role in assessing the skin’s barrier
function.15 Several studies have used TEWL to monitor stratum cor-
neum (SC) damages resulting from exposure to surfactants and have
reported that TEWL had good correlation with subjective assess-
ment of irritancy.16 Grunewald et al.17 confirmed that TEWL and
hydration measurements can discover chronic skin damage at an ear-
lier time. Tupker et al. have used only TEWL as an indicator for the
damage to the skin caused by surfactants. They concluded that it is
possible to rank the detergents according to their irritation potential
by using TEWL.18 Subjective evaluation of irritation caused by a vari-
ety of toilet soaps correlated well with increased TEWL.
In our study, the baseline values of TEWL and erythema
observed at the anterolateral surface of the forearm can be consid-
ered as normal values and are in agreement with previously pub-
lished data.19
Although in this study, all four different soaps increased TEWL
24 hours after path rest application, this change was significant only
for traditional alkaline and creamy soaps. Seventy‐two hours after
the exposure, only the traditional alkaline soap had significantly high
TEWL, which indicates that this soap is more irritant than other
ones. The main components of traditional alkaline soap and creamy
one are NaOH and anionic surfactants, which both are known to be
24 hr. after 72 hr. after
removing removing
patches patches
Second Third
measurement measurement
TEWL, Erythema TEWL, Erythema
4 |
30
25
TEWL(g/h.m2)
20
15
10
0
SDS 20%
*: significant @ P< 0.01
FIGURE 2 Comparison of TEWL after 4‐h patch test of four different soaps
300
250
Erythema level (AU)
200
150
100
50
0
SDS 20%
*: significant @ P< 0.01
FIGURE 3 Comparison of erythema index after 4‐h patch test of four different soaps
irritants to the skin. They degrease the SC from functional lipids
such as ceramides and cholesterol. Also, the surfactants bind to the
SC proteins and cause temporary swelling of cells along with hyper
hydration. After washing, deswelling occurs leading to the develop-
ment of empty spaces between the cells, leading to, an increase in
TEWL of the skin.20
Angelova‐Fischer et al.21 confirmed that exposure to alkaline
agents such as NaOH will lead to an increase in the skin pH, and this
event will alter the activity of the enzymes involved in the degrada-
tion of filaggrin. Filaggrin is necessary for proper SC hydration, and
its degradation decreases the levels of natural moisturizing factors
(NMF), which leads to dry skin. Glycerin and creamy soaps also have
the same anionic surfactants and soda, but adding glycerin as a
humectant or lanolin as an emollient reduces TEWL and diminishes
adverse reactions of NaOH and anionic surfactants. In the case of
creamy soap, lanolin as an emollient ingredient neutralized some
harmful effects and made creamy soap softer than traditional alka-
line one. Therefore, the TEWL returned to baseline after 72 hours.
The syndet bar with its synthetic surfactants has neutral or slightly
acidic pH. So the cell swelling and skin irritation and dryness are
much less with syndet bar.20 In this study, syndet bar did not induce
significant changes in TEWL.
Erythema in the skin occurs when skin is exposed to irritants
such as chemical substances, cleansers, allergens, or UV. Erythema
and melanin are useful indicators of integrity of the skin barrier.22
KHOSROWPOUR ET AL.
*
*
before
after 24 Hour
* *
* after 72 Hour
syndet pH=5.5 glycerin soap creamy soap alkaline soap H2O
before
* after 24 Hour
after 72 Hour
syndet pH=5.5 glycerin soap creamy soap alkaline soap H2O
Yamamoto et al.23 showed that erythema index could be used in a
variety of dermatological studies, such as patch test, UV‐irradiation
test, quantitative evaluation of blood volume in granulation tissue in
chronic skin ulcer, and quantitative evaluation of treatments for vas-
cular or pigmented skin lesions. Paye et al.24 made a comparison
between a soap, a syndet, and a face cleanser and stated that soap
causes more skin irritancy and dryness with the highest TEWL and
erythema.
Erythema was the second parameter that we measured in this
study. The erythema index was reduced significantly 72 hours after
the patch test with creamy soap, which could be due to the pres-
ence of lanolin as an emollient agent in the formulation of this
soap.7,25 This trend was also noticed for syndent and glycerin soaps,
although not statistically significant.
5
In the case of traditional alkaline soap (unlike the others), ery-
thema index, 24 and 72 hours after exposure, continued to increase,
although this increase was not statistically significant.
5 | CONCLUSION
In conclusion, 4‐hour patch test demonstrated that traditional alka-
line soap (containing plenty of anionic surfactant and NaOH) causes
the highest increase in TEWL and erythema than other soaps. This
probably indicates that epidermal damage caused by alkaline soap is
more severe than the other types of soaps, and skin requires more
KHOSROWPOUR ET AL.
time to repair itself. Acidic pH of syndet makes it less damaging than
alkaline soap. Also glycerin and creamy soaps have additives like
emollients and humectants, which diminish the destructive effect of
alkaline‐base of these soaps. So we suggested to choose routine
soaps for daily consumption by the following order: glycerin soap,
syndent, creamy soap, and traditional alkaline soap.
ACKNOWLEDGMENT
This study was supported by research grant number 95‐03‐34‐
32801 from Center for Research and Training in Skin Diseases and
Leprosy, Tehran University of Medical Sciences.
ORCID
Zeynab Khosrowpour http://orcid.org/0000-0002-0781-8900
Saman Ahmad Nasrollahi http://orcid.org/0000-0002-7384-6686
Aniseh Samadi http://orcid.org/0000-0002-0134-429X
Alireza Firooz http://orcid.org/0000-0001-7274-4840
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How to cite this article: Khosrowpour Z, Ahmad Nasrollahi S,
Ayatollahi A, Samadi A, Firooz A. Effects of four soaps on
skin trans‐epidermal water loss and erythema index. J Cosmet
Dermatol. 2018;00:1–5. https://doi.org/10.1111/jocd.12758