Accepted: 18 November 2017

DOI: 10.1111/jocd.12469

REVIEW ARTICLE

The science behind skin care: Cleansers

Zoe Diana Draelos MD

Dermatology Consulting Services, PLLC,

High Point, NC, USA
Correspondence
Zoe Diana Draelos, Dermatology Consulting
Services, PLLC, High Point, NC, USA.
Email: zdraelos@northstate.net
Summary
Two of the most important skin care categories with profound dermatologic implica-
tions are cleansers and moisturizers. Cleansers are composed of alkaline soaps or
the less barrier-damaging synthetic detergents, known as syndets. The lower skin
irritation and dryness found with syndets are related to their reduced tendency to
cause protein denaturation due to the charge density of protein-bound micelle-like
surfactant aggregates. Many cleansing formulations are available for purchase to
meet hygiene needs varying by sex, age, ethnicity, occupation, environment,
personal preferences, and the presence or absence of skin disease. This discussion
covers the science of skin cleansing.

KEYWORDS
antibacterial, cleansers, detergents, personal hygiene, soaps, surfactants

1 | INTRODUCTION
Cleansing is a key daily activity relevant in both skin disease and
health. It is a relatively modern concept coinciding with the mass
use of commercially available soap beginning in the early 1900s. The
first cleansers were composed of potash, a derivative of burnt wood
ash, and triglycerides obtained from hydrolyzed animal fat yielding
potassium soap used by the Sumerians in 2500 BC. Soap was the
major import of the US from Italy and France until 1878 when Har-
ley Procter turned his father’s candle factory into a soap factory,
with the help of his chemist cousin James Gamble, producing a
creamy white soap to compete with the imported European prod-
ucts. By accident, they discovered that whipping air into the soap
solution prior to molding resulted in a floating bar that could not be
lost when bathing in the Ohio River, and “white soap” was born
(Ivory, Procter & Gamble).1
2 | CLEANSER COMPOSITION
There are many different types of cleansers available for purchase
with unique compositions and specific skin benefits. The term soap
is used loosely to refer to any cleanser; however, this is not correct
as soap denotes a specific chemical entity. Soap is created when a
fat interacts with an alkali resulting in a fatty acid salt with detergent
properties.2 Modern commercial soaps are a blend of tallow and nut
oil, or the fatty acids derived from these products, in a ratio of 4:1.
Altering the ratio modifies the cleansing ability of the formulation.
For example, increasing this ratio results in “superfatted” soaps tou-
ted for their cleansing “mildness.” It is the excess fatty acid that
reduces the ability of the cleanser to remove lipids; thus, these prod-
ucts are marketed as “sensitive skin” cleansers. These soaps can be
packaged as bars or liquids.
The most common cleanser formulations marketed today are
composed of synthetic detergents, known as syndets, and possess a
lower alkaline pH resulting in less removal of intercellular lipids.
Soaps typically have a pH of 9-10 while syndets are formulated at a
pH of 5.5-7, closer to the natural neutral skin pH.3 It is possible to
combine both soap and syndet cleansers into a formulation known
as a combar, so named as a contraction of combination bar, provid-
ing better cleansing with less lipid disruption (Table 1).4
Cleansers are also classified based on their charge, which affects
their cleansing characteristics. Soap is a simple anionic surfactant
with a high pH.5 The high pH causes swelling of the stratum cor-
neum, which allows unwanted deeper penetration of the soap into
the skin possibly causing irritation and itching.6 The soap also binds
to stratum corneum proteins further inducing swelling and hyperhy-
dration of the skin. Following the completion of washing, the excess
water evaporates leading to skin tightness and dryness because the
soap binding reduces the ability of the skin proteins to hold water.
This explains the reduction in skin hydration and elasticity following
soap cleansing.7

8 | © 2017 Wiley Periodicals, Inc. wileyonlinelibrary.com/journal/jocd J Cosmet Dermatol. 2018;17:8–14.

DRAELOS
T A B L E 1 Cleanser categories
Cleanser
type Composition
Traditional Animal fat interacting with an alkali, such as lye,
soaps resulting in a fatty acid salt
Modern Blend of tallow and nut oil, or the fatty acids
soaps derived from these products
Syndets Synthetic detergents: sodium lauryl sulfate,
sodium laurate, and sodium cocoyl isethionate
Combars Combine modern soap and synthetic detergents
The reduced irritation and dryness seen with syndets are related
to their reduced tendency to cause protein denaturation due to the
charge density of protein-bound micelle-like surfactant aggregates.8
Thus, anionic surfactants, such as sodium lauryl sulfate and sodium
laurate and sodium cocoyl isethionate, are more irritating than
amphoteric surfactants, such as cocamidopropyl betaine, which are
more irritating than nonionic surfactants, such as alkyl polygluco-
side.9 Picking a combination of surfactants with different properties
can modify cleanser mildness.10
Finally, the ability of the cleanser to rinse completely from the
skin is important. As all soaps and syndets are irritating, they must
not remain on the skin any longer than necessary. In cases where
patients have mistakenly thought a moisturizing cleanser should
remain on the skin to maximum benefit, irritant contact dermatitis
has occurred.11
3 | CLEANSER FORMULATIONS
3.1 | Bar cleansers
Bar cleansers remain the most widely used form of cleanser in the
United States; however, liquids are gaining in popularity. Many dif-
ferent types of bar cleansers are currently produced, summarized in
Table 2. The typical bar cleanser composition is a combination of
two surfactants: the soap alkyl carboxylate and the syndet acyl
isethionate. Alkyl carboxylate and acyl isethionate are both anionic
surfactants, but the carboxylate group is most damaging, binding,
and denaturing stratum corneum proteins. The syndet acyl isethion-
ate is less damaging because it does not bind as readily. It was the
combination of acyl isethionate with stearic acid, which acts as a
moisturizing cream depositing on the skin surface during cleansing,
that allowed the introduction of a milder bar cleanser in 1957 (Dove,
Unilever).12
Bar cleansers are manufactured by mixing the surfactant with
other ingredients to extrude a continuous bar that is chopped and
stamped into the final bar shape. More expensive bars may be man-
ufactured by pouring the hot liquid cleanser into a mold that is
allowed to cool. There are two unique bar cleansers manufactured
relevant to the dermatologist: glycerin and antibacterial. Glycerin
bars, developed in 1789 by Andrew Pears, are clear and contain
sodium palmitate, glycerin, and soap dissolved in alcohol followed by
| 9
pH Skin issues Examples
9-10, strongly Excessive removal of intercellular lipids, Homemade
alkaline stratum corneum swelling soaps
9-10, strongly Removes intercellular lipid, less stratum Ivory (P&G)
alkaline corneum swelling
5.5-7, neutral to Less alkaline pH reducing protein denaturation Dove
slightly alkaline (Unilever)
7, slightly alkaline Intermediate skin damage between soap and Dial
syndet, includes most antibacterial bars (Henkel)
pouring into molds and curing for 3 months. The original transparent
glycerin bar was improved upon in 1955 when the Belgian Edmond
Fromont substituted triethanolamine stearate for the usual sodium
palmitate, which lowered the pH of the bar to 8-9, accounting for
improved mildness (Neutrogena Bar, Johnson & Johnson).13
A variant of the combar formulation is the antibacterial or
deodorant bar. This cleanser contains an antibacterial ingredient,
becoming an OTC drug required to follow monograph guidelines.
Most antibacterial bars used to contain triclosan (2,4,40 -trichloro-20 -
hydroxydiphenyl ether), a chlorinated phenolic compound killing
gram-negative bacteria through cell membrane damage. In Septem-
ber 2016, the US FDA announced that effective from September
2017 it would prohibit the sale of triclosan and 18 other ingredients
marketed as antimicrobials due to lack of proven efficacy in these
products.14 Most manufacturers of deodorant bars now use benza-
lkonium chloride, an organic salt classified as a quaternary ammo-
nium compound, a cationic surfactant, as the antibacterial to kill
odor-causing body bacteria. However, benzalkonium chloride is also
under FDA consideration for banning, except the ban was deferred
to allow ongoing studies regarding its topical efficacy to be com-
pleted.15
3.2 | Liquid cleansers
Liquid cleansers have a composition similar to bar cleansers, except
they are poured from a bottle. A popular liquid product with derma-
tologic relevance is a body wash, designed for use in the shower
with a puff cleansing implement. Body washes are unique in that
they can cleanse and leave behind a moisturizing residue, useful in
patients who wish to bathe frequently with eczematous der-
matoses.16 Water is the primary ingredient with the syndets sodium
lauryl sulfate and cocamidopropyl betaine added to solubilize lipophi-
lic dirt and provide bubbles and lather, which most consumers view
as necessary for effective cleansing.5 To the syndets, lipophilic mois-
turizing ingredients are added, such as petrolatum, vegetable oils, or
shea butter.
A body wash can both cleanse and moisturize by taking advan-
tage of the two stages of cleansing based on differing concentrations
of water and cleanser. During the cleansing phase, there is a high
concentration of cleanser and a low concentration of water. The
syndet binds to the oil-soluble dirt and prepares it for removal from
10 | DRAELOS

T A B L E 2 Bar soap formulations sized amount to clean the entire body minimizing skin/surfactant
Bar soap type Formulation details contact.

Superfatted Increased fat, up to 10%

Castile Olive oil added as fat 3.3 | Hand cleansers
Deodorant/ Antibacterial agent added to kill odor-causing
Antibacterial bacteria, OTC Drug, and composition Hand cleansers, also known as hand sanitizers, are waterless cleans-
regulated by monograph ers designed to remove bacteria from the hands based on alcohols
French Milled Milder formulation with lower pH and quaternary ammonium compounds, which possesses different
Floating Air introduced into soap by whipping antimicrobial properties and act through different mechanisms.18,19

Oatmeal Ground oatmeal added, whole oats create a The most commonly used hand cleansers contain ethanol, which has
more exfoliating bar, while oat powder excellent killing against both gram-positive and gram-negative bacte-
creates a bar with less exfoliation ria and fungal organisms. However, ethanol is not effective against
Acne OTC drug, composition regulated by bacterial spores and has variable efficacy in killing enveloped viruses.
monograph, may contain sulfur, salicylic acid, Ethanol hand sanitizers are flammable and cannot be used where
or benzoyl peroxide
open sparks are present, such as in the operating room around elec-
Facial Smaller bar size
trocautery equipment.20
Bath Larger bar size Quaternary ammonium compounds, such as benzalkonium chlo-
Botanical Ingredients: Botanical ingredient added to soap, no special ride or benzethonium chloride, adsorb to the cytoplasmic membrane
Aloe Vera/ skin benefit in a rinse-off product, no special
of microbes causing leakage of cytoplasmic contents. They are bac-
Chamomile/ claims possible
Lavender teriostatic against gram-positive bacteria and some gram-negative

Vitamin E Vitamin E added for marketing purposes, no bacteria and fungistatic. They are not active against nonenveloped
special skin benefit in a rinse-off product viruses. It is interesting to note that some species of Staphylococcus
Cocoa Butter Cocoa butter used as fat aureus carry a gene that allows resistance to quaternary ammonium
Nut Oil/Fruit Oil Nut oil or fruit oil used as fat compounds. These organisms are also more likely to be antibiotic

Transparent/Glycerin Glycerin added does not reduce barrier resistant, as well. Quaternary ammonium compound hand sanitizers
damage may not be the best choice where methicillin-resistant Staphylococ-
Heavy Duty Abrasive Ground pumice used as grit to exfoliate cus aureus (MRSA) is a concern.21
stained skin While hand sanitizers may be important in limiting the spread of
Exfoliating Plant material (nut kernels, dried herbs, fruit contagious disease, they are not effective against anthrax and
pits, etc.) added to physically exfoliate the Clostridium difficile.22 Hand sanitizers are not good at removing visi-
skin
ble dirt from the hands and are best used on clean hands that might
Soap-free Contains syndets (synthetic detergents) contain nonvisible dirt.23 While hand sanitizers can solubilize inter-
Natural No formulation meaning, consumer marketing cellular lipids, a study in healthcare workers demonstrated better
appeal
skin condition with the use of hand sanitizers as opposed to
Organic No formulation meaning, consumer marketing
frequent hand washing.24
appeal
Handcrafted Bar molded by hand instead of poured or
machine-molded offers no cleansing benefit
4 | CLEANSERS AND SKIN DAMAGE

Cleansing requires a delicate balance between skin hygiene and stra-

the skin. During the rinse phase, where cleanser concentration is low
and water concentration is high, the dissolved oil-soluble dirt and
the water-soluble dirt are rinsed from the body and cleansing is
complete. However, when the water concentration is high, the mois-
turizing ingredients are deposited on the body in a thin film.16 The
amount of moisturizing ingredient left on the skin surface can be
varied based on the size of the droplets placed in the water-based
emulsion. Standardized testing methodologies have been developed
to assess the balance between cleansing and moisturizing.17
Body washes are best applied with a large surface area mesh
polyethylene bundle, known as a puff, which breaks the cleanser
emulsion by adding copious amounts of water and air. This allows
the body wash to foam and allows the patient to use only a dime-
tum corneum barrier damage. The act of cleansing is a complex
physical and chemical interaction between water, detergent, and the
skin. During cleansing, micelles are created with external hydrophilic
groups surrounding an internal lipophilic pocket. These micelles can
surround oily substances, such as sebum, dispersing the oil in water
for removal and rinsing.25
Cleansers are effective at maintaining skin hygiene and a healthy
biofilm, but may cause skin barrier damage, worsening eczematous
skin disease. This arises because surfactants cannot distinguish
between lipophilic skin soils requiring removal and the lipophilic
intercellular lipids required for barrier maintenance. The bipolar
structure of skin soils is similar to the fatty acids, cholesterol, and
ceramides comprising the lipid bilayers of the stratum corneum.26
DRAELOS
T A B L E 3 Testing methods for cleanser skin mildness
Irritation evaluation
Testing technique parameter
Collagen Swelling Test (In Vitro) Increased protein
uptake of cleanser
pH Rise Test (In Vitro) Increased pH
Zein Test (In Vitro) Increased protein
denaturation
Forearm Controlled Application Technique Skin irritation
(FCAT) (In Vivo)
Surfactant barrier damage increases transepidermal water loss
(TEWL) and facilitates removal of the natural moisturizing factor
(NMF). This leads to alterations in stratum corneum function and
desquamatory failure with increased corneocyte retention. This is
the mechanism by which surfactants induce the rough, scaly appear-
ance characteristic of eczematous dermatoses.27
The chemical soap component that causes barrier damage is the
high charge density of the carboxyl head group, which promotes
strong protein binding. This characteristic insures excellent cleansing
and removal of protein soils, but damages the stratum corneum pro-
teins, denatures enzymes, and alters corneocyte water-holding capa-
bility.26 It is possible to predict the barrier-damaging characteristics
of a soap formulation by examining the balance between shorter sol-
uble chains (C12, C14) and longer less soluble chain lengths (C16,
C18) of the soap fatty acids. Soaps with a higher soluble short-chain
component are less skin damaging.27 Shorter soluble chains are plant
derived, such as C12 coconut fatty acids, while longer soluble chains
are animal derived, such as C18 rendered animal fat. Thus, the
shorter chains are preferred due to reduced barrier damage and an
increased lathering ability.
Barrier damage is also influenced by cleanser pH. Soap typically
has an alkaline pH of 10-11, producing skin protein swelling and ion-
ization of the lipid bilayers. Thus, synthetic detergents with more
neutral pH of 5-7 minimize barrier damage and are the preferred
cleanser for individuals with dermatologic disease.10 Methods used
to test cleansers for mildness are summarized in Table 3.
5 | SPECIALTY CLEANERS
The basic bar, liquid, and waterless cleansers have been discussed;
however, many other important formulations exist of importance to
the dermatologist. These cleansers are designed to promote hygiene
while offering an additional skin benefit (Table 4).
5.1 | Cold cream cleansers
The original cleanser for cosmetic removal and mild facial cleansing
invented by Theron T. Pond in 1846 was known as “cold cream” and
is still popular today. Cold cream, composed of water, beeswax, and
mineral oil, uses fats to solubilize lipophilic skin soils.28 Beeswax and
| 11
Method
Collagen sheet incubated at 50°C with solution of cleanser for 24 h
2% solution of bovine serum albumin at pH 5.6 with 2% solution of
cleanser for 1 h
Insoluble protein in aqueous solution exposed to cleanser
Exaggerated use test with controlled forearm cleansing twice daily,
separated by 3 h, for 4 d
mineral oil function as lipid solvents that combine with the detergent
action of borax, also known as decahydrate of sodium tetraborate,
to cleanse the face.29 The formulation also contains ceresin and car-
bomer to thicken the cream and fragrance. The cold cream is wiped
on with the fingers, wiped off with a tissue, and may be rinsed or
left on the face. Cold cream is an excellent facial cleanser and cos-
metic remover for patients with dry skin.
5.2 | Cleansing milks
A thinner variant of cleansing cream is cleansing milk, without the
more viscous waxes, designed for normal to combination skin.
Cleansing milk contains water and lightweight oils, such as olive oil,
sunflower oil, jojoba oil, or sesame seed oil, and emollients, such as
glycerin, making it less likely to leave a facial residue. The oils are
emulsified into the water making cleansing milks an oil-in-water
emulsion providing cleansing by dissolving, as opposed to emulsify-
ing, skin soils. The liquid is dispensed from a bottled and wiped over
the face with cotton pad.30 The cleanser can be wiped off or wiped
first followed by water rinsing. Cleansing milks are commonly used
for the removal of eye cosmetics; as they are nonirritating and do
not readily blur vision with an oily residue.
5.3 | Cleansing oils
Cleansing oils are a water-in-oil emulsion primarily used for the
removal of facial or eyelid waterproof cosmetics and waterproof
sunscreens that cannot be easily removed with soap and water. The
oil is spread over the face with a cotton pad, rubbed, and rinsed
away with water. The clear oil will turn milky when water rinsed.
Mineral oil, castor oil, jojoba oil, and olive oil are commonly used.
Olive oil can be comedogenic; thus, the cleansing oil should be thor-
oughly water rinsed and might require the addition of a detergent
for complete removal.
5.4 | Oil cleansing balms
Oil cleansing balms are similar to cold cream cleansers, except they
have a petroleum jelly consistency at room temperature liquefying
when they come in contact with the warm facial skin. These prod-
ucts are used to remove waterproof stage and surgical cosmetics, as
12 | DRAELOS

T A B L E 4 Cleanser selection based on skin type

Facial cleanser Skin type
category Mechanism of action suitability Unique attributes
Bar soap Emulsification Oily Excellent sebum and skin soil removal
Syndet bar Emulsification Normal to Reduced skin barrier damage
oily
Antibacterial bar Emulsification Normal to Decreases colonization of odor-causing bacteria
oily
Syndet liquid Emulsification Normal to dry Reduced skin barrier damage
Body wash Emulsification followed by Dry Cleansing/moisturization occurs simultaneously
Deposition
Cold cream Dissolution Dry Poor sebum removal, excellent for facial cosmetic removal, leaves behind
moisturizing film
Cleansing milk Dissolution Normal to dry Excellent facial cleanser for diseased skin
Cleansing oil Dissolution Dry Poor sebum removal, excellent for very dry skin and excellent for waterproof
sunscreen removal
Cleansing balm Dissolution Dry Poor sebum removal, excellent for waterproof cosmetic removal, may need to
follow with a liquid syndet cleanser
Micellar water Emulsification All Excellent for facial cosmetic removal
Nonfoaming Emulsification Dry to normal Useful cleanser in diseased skin
cleanser
Cleansing scrub Emulsification and physical Oily Particulate can produce aggressive pore cleansing and exfoliation
skin soil removal
Cleansing cloth Emulsification and physical All Cloth weave can vary cleansing characteristics from mild open weave to
skin soil removal aggressive closed weave
Medicated Emulsification Oily, Acne OTC drug may contribute to acne treatment
cleanser prone
Toner Dissolution All Alcohol-based for enhanced sebum removal, Propylene glycol based for
sensitive dry skin

well as waterproof sunscreens. The thick balm is oil based containing
mineral oil, sunflower oil, olive oil, coconut oil, mango seed butter,
apricot kernel oil, sweet almond oil, grapeseed oil, orange peel oil,
avocado oil, etc. These oils are combined with either beeswax or
shea (Butyrospermum Parkii) butter to create a thick spread mas-
saged over the face with the fingers in a circular motion to also
remove waterproof products from the pores. Many products come
with a muslin cloth to moisten with warm water to aid in rubbing
the product thoroughly over the face. With continued rubbing, the
product will become a liquid that can be wiped away with the rinsed
muslin cloth leaving an oily residue. It may be necessary to follow
the cleansing balm with soap and water cleansing in patients with
oily skin.
5.5 | Micellar water cleansers
Micellar water cleansers, also known as cleansing waters, contain
water and a very mild surfactant representing a dilute cleansing solu-
tion. A micelle is a molecular cluster with a hydrophilic and a
hydrophobic end, in this case, dissolved in a water solution. The
hydrophobic end attaches to the skin soils, dissolving the soil in
water through the hydrophilic end and allowing water rinsing to
cleanse the face. Several different surfactants can be used such as
cetrimonium bromide, a cationic quaternary surfactant also known as
a “quat.” Quats are mild surfactants commonly found in hair condi-
tioners to allow the excess conditioner to water rinse down the
drain preventing the hair from appearing greasy. Polysorbate 20 is
also used because it is a nonfoaming surfactant. Amphoteric surfac-
tants of the type found in baby shampoo can also be used, such as
disodium cocoamphodiacetate. The product is stroked on the face
with a cotton pad, rubbed to remove skin soils, and rinsed with
water. Micellar water is excellent at removing water-soluble cosmet-
ics or facial cleansing in patients with dry, sensitive skin.
5.6 | Nonfoaming cleansers
Many of the cleansers dermatologists recommend for sensitive skin
or patients with atopic dermatitis are considered nonfoaming cleans-
ers because they do not lather (Cetaphil Gentle Cleanser, Galderma;
CeraVe Cleanser, Valeant).31 Nonfoaming cleansers may contain
water, glycerin, cetyl alcohol, stearyl alcohol, sodium lauryl sulfate,
and occasionally propylene glycol. The sodium lauryl sulfate func-
tions as the surfactant and the glycerin, cetyl alcohol, and stearyl
alcohol leave behind a thin moisturizing film on the skin surface.
These cleansers are applied to either dry or water-moistened skin,
rubbed, and water rinsed or tissue wiped away. They leave behind a
DRAELOS
thin moisturizing film and can be used effectively to remove facial
cosmetics and have been shown to cause less cutaneous irritation in
photoaged skin.32
6 | THE FUTURE OF CLEANSING
The future of cleansing is overcoming the challenge of providing
excellent skin hygiene while minimizing skin barrier damage. This
challenge has not yet been met. Surfactants cannot differentiate
between sebum and oil-soluble skin soils and the lipophilic sub-
stances composing the intercellular lipids. Smart surfactants are not
yet a reality. One popular technique is to add ceramides, fatty acids,
cholesterol, and/or triglycerides to a cleanser hoping to perhaps
replenish some of the components of lost intercellular lipids removed
during cleansing. The problem with this approach is the short con-
tact time between the cleanser and the skin. Cleansers should
remain on the skin for as short a period as possible to minimize stra-
tum corneum protein damage; however, this short contact does not
allow time for ingredients to penetrate and remain in the skin. Fur-
ther, if ceramides really penetrated into the stratum corneum from a
cleanser, then so too would the surfactants causing accelerated bar-
rier damage.
A novel approach to skin cleansing is the addition of hydrophobi-
cally modified polymers (HMPs) to surfactants to create a polymer/
surfactant complex that is functional, aesthetic, and mild. The HMPs
interact with the hydrophobic tails of the surfactant, forming larger
surfactant structures that cannot readily penetrate the stratum cor-
neum. The binding of the HMPs also lowers the surfactant concen-
tration in the micelles formed during cleansing decreasing protein
damage. Finally, HMPs provide for increased foam formation, a
cleanser trait consumers find desirable.33 This method basically
increases cleanser mildness by reducing skin permeability.34
Finally, there is a need for better testing methodologies that can
predict cleanser-induced damage more reliably.35 Cleansing probably
has done more to improve the human condition than any other
invention. Improved personal hygiene, reduced cutaneous infection,
less spread of contagious disease, and beautification of the skin are
all attributes ascribed to cleansers.
CONFLICT OF INTEREST
The author involved with this journal-based CME activity has
reported no relevant financial relationship with commercial interests.
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How to cite this article: Draelos ZD. The science behind skin
care: Cleansers. J Cosmet Dermatol. 2018;17:8–14.
https://doi.org/10.1111/jocd.12469