Irritancy ranking of 31 cleansers in the Indian market in a 24-h patch test

Cleansing trends promise freshness, sensory and health benefits but may also be accompanied by an increase in soap-induced skin irritation. The aim of this study was to evaluate the irritant effect of 31 cleansers (28 bar soaps and 3 liquid cleansers) available in the Indian market. Eight percent w/v solutions of the soaps/cleansers were made and 30 microL of each of the solutions were applied to Finn chambers and occluded for 24 h along with distilled water (negative control) and 20% sodium dodecyl sulphate (SDS) as positive control. The sites were graded for erythema and scaling 30 min after removing the patches. The pH of each of the soap solutions was determined. Mean with SD and ANOVA (F-value) was computed separately for each soap/cleanser with respect to the two parameters, erythema and scaling. The total of the means for both the parameters, erythema and scaling was also computed. The cleansers were listed based on this total from the least irritant to the most irritant. The differences between soaps (F-value) was significant for erythema and scaling [erythema = 4.106 (P = 0.000); scaling = 6.006 (P = 0.000)]. Cetaphil cleansing lotion had the lowest erythema score of 0.25. Lowest scaling score of zero was recorded for Cetaphil cleansing lotion and Elovera moisturizing body wash. Aquasoft and Lifebuoy soaps had the highest erythema score of 2.13. Acnex had the highest scaling score of 1.75; Aquasoft, Hamam scrub bath soap and Naturepower sandal soaps were the next with a scaling score of 1.63. Cetaphil cleansing lotion, Aquaderm liquid soap, Dove bar soap and Elovera moisturizing body wash proved to be the least irritant cleansers with a total score of less than 1. The four most irritant soaps/cleansers had an average score of 3.65. The irritant potential of the majority of the cleansers fell between these extremes. The pH of all the soap/cleanser solutions was neutral to alkaline (pH 7-9) except that of Dove bar, Cetaphil cleansing lotion, Aquaderm liquid soap and Elovera moisturizing body wash which tested acidic (pH 5-6). The pH of the positive control--20% SDS, was acidic (pH 6). The difference in the irritancy potential between soaps/cleansers as determined by the 24-h patch test was significant. There were individual variations in the irritant potential of the soaps/cleansers in the volunteers, thus when the patient queries on what soap to use, it may be advisable to test each patient separately and educate him/her regarding the soaps/cleansers less likely to cause irritation. The limitations of the study was that it was single blind and non-randomized as all the 14 soap solutions were applied on 15 volunteers in the first panel and subsequently all the 17 soap solutions were applied on eight volunteers in the second panel. However, we could compare the irritant potential of 31 cleansers. The results of 24-h patch testing of 31 soaps/cleansers in the Indian market in two panels of 14 and 17 soaps/cleansers on 15 and eight volunteers, respectively, are presented.