Is soap and water enough?

US drug regulator, the Food and Drug Administration recently banned 19 chemicals used in antibacterial soaps and ordered soap manufacturers to remove them within a year. What do medical experts in Kenya have to say about this? GARDY CHACHA speaks to a few of them

Two years ago, Joyce gave birth to her first born – a son. To say she was excited would be an understatement.

“I was on cloud nine,” she says. “I have never felt so much joy and euphoria in my life like I did at that moment.”

She vowed to give her son nothing but the best: the best clothes; the best coat; the best toys. Soaps, ointments and other topical applications had to be the best too.

“I bought everything that offered my child the best protection; from antibacterial soaps to antiseptic applications,” she says.

But then her son started developing ‘allergic reactions’ and disease-like skin eruption. Even before the boy could understand the real pain of life on earth he was already afflicted with skin conditions.

She explains: “It happened three times. Every time I went to our neighbourhood clinic I would be offered some topical medicine to apply. But it didn’t stop.”

When her son hit six months, Joyce sought the opinion of a paediatrician at an established hospital. The advice she received mentioned just the right antidote to her son’s incessant allergic reactions.

“The paeditrician told me to stop using anything written ‘antibacterial’ and go back to using plain soap. That I drop all the ‘fancy’ prepared lotions and instead use a jelly famous for milking cows.”

Joyce was astonished. How could it be that the best and the most expensive soaps and oils could be the source of her son’s troubled itchy skin?

She took the paeditrician’s advice, albeit with a pinch of salt. “It worked. The first month went by without anything. So did the second, the third and the fourth. I was happy that his skin was no longer problematic. But I also felt stupid,” she says.

Dr Eliud Monda, a dermatologist at International Skin and Medical Clinic says: “There is no scientific proof that antibacterial soaps do better or worse than regular plain soap,” he says. “There is proof however that regular soap do perfectly well in cleaning the body. In other words, antibacterial soaps are not necessary to get the job done: regular soap gets rid of dirt and bacteria well enough,” he says.

In the United States, Food and Drugs Administration (FDA) banned more than a dozen chemicals long-used in antibacterial soaps, saying manufacturers failed to show they are safe and kill germs.

“We have no scientific evidence that they are any better than plain soap and water,” said Dr Janet Woodcock, FDA’s director, in a statement sent to the press.

“Consumers may think antibacterial washes are more effective on germs. In fact, some data suggests that antibacterial ingredients may do more harm than good over the long-term,” Woodcock’s statement read in part.

More harm than good? That definitely doesn’t sound right to Joyce.

“It is wrong. Personally I choose the soaps I was using on my son because of the advertisements I had seen all over media. The results were skin conditions that provoked itchiness. How would I know if there was more damage internally?” she asks.

Dr Jacqueline Kitulu, the chairperson at Kenya Medical Association (KMA), believes that parents ought to read through contents of products before using them on their children.

“America’s FDA has listed Triclosan, Triclocarban and 17 other ingredients among those banned from use in manufacturing soaps,” Dr Kitulu says. “Triclosan is linked to liver and inhalation toxicity. Triclosan and other antibacterial ingredients may encourage bacterial resistance to antibiotics.”

Dr Supa Tunje, a paediatrician at Adora Children’s Clinic in Kitengela has the same conclusion as Dr Monda. She has handled hundreds of patients and every time a parent arrives at her clinic with a case of ‘allergic reaction’ she would assess and recommend regular soap for their child.

“For children, the use of antibacterial soap is one that needs a lot of care. Infants (and children under one) have very thin skin. They are therefore more sensitive to harsh products laden with a lot of chemicals, which is most often the case with antibacterial soaps,” Tunje observes.

She further argues that antibacterial soaps are meant for medical use only: when there is a wound on the skin. But in otherwise normal situations, clean water alone, she says, can do the job “even without using any soap.”

And if you didn’t know this get it from Dr Tunje: plain water is able to deal with over 90 per cent of germs. When regular soap is used nearly all dirt and harmful bacteria is gotten rid of.

This was also captured in a Korean study done in 2015. Dr Min-Suk Rhee of Korea University, The paper’s lead author, is quoted rebuking marketing, asking that their methods need to be addressed.

The study, published in the Journal of Antimicrobial Chemotherapy, found that hand washing using antibacterial soap does not kill more bacteria than plain soap.

Dr Tunje is, however, more worried with the real danger of destabilising normal microbial flora found on the skin by killing them through daily use of antibacterials.

She says: “The skin has its own natural bacteria which protects it against pathogens. Antibacterials won’t discriminate the good and the bad bacteria on your skin. It will kill all. By so doing it leaves your skin exposed to bad bacteria – and therefore prone to infections which you were trying to avoid in the first place.”

Routine use of antibacterial soaps, she adds, will help allow drug-resistant germs known as superbugs to emerge that cannot be killed by available antibiotics. Dr Kitulu maintains that the safety of consumers is what KMA strives for, the concern for the medical fraternity, and “we will continue to advocate for product safety,” she says.

The FDA and the Centers for Disease Control and Prevention agree that soap doesn’t need added antiseptics to make it work any better.

“Washing with plain soap and running water remains one of the most important steps consumers can take to avoid getting sick and to prevent spreading germs to others,” the FDA said.

A study by University of Oregon scientists found that anti-microbial chemicals like triclosan contained genes linked to antibiotic-resistant bacteria and hence the worry for the rise of super bugs.