dermatology, environmental medicine

antibacterial soap: the dirty truth

You may have heard recently that the FDA issued a proposal to reevaluate the use of antibacterial agents in over-the-counter hand soaps. I can’t say I was disappointed! Although I once took comfort in the idea of antibacterial soap, over the last several years I have chosen to avoid products with the active ingredient triclosan.

My microbiology professor used to say that it takes 30 seconds of skin contact for triclosan to effectively kill bacteria. I don’t know about you, but I rarely see anyone wash their hands for that long — unless maybe they’re scrubbing for surgery. This means that we are flushing millions of gallons of triclosan-contaminated water (not to mention good money) down the drain for virtually no reason.

What happens then? Well, nothing good. Triclosan is poorly biodegradable and not easily removed during waste water treatment, so it enters waterways where it is detrimental to algae, fish, and other aquatic life via acute toxicity as well as disruption of reproductive function. Most municipal water supplies are also heavily chlorinated; triclosan reacts with chlorine to produce chloroform and other toxic metabolites.

Since it remains in the water supply, triclosan eventually makes its way back into our homes — and therefore into our bodies as well. Measurable levels of triclosan are found in the urine of 76% of Americans and evidence increasingly seems to show that triclosan may act as an endocrine disruptor. Estrogenic and androgenic effects may impact fetal development, breast cancer cell growth, obesity, and more. Systemic exposure has also been linked with an increased risk of allergic sensitization to environmental or other inhaled allergens (although skin contact with triclosan does not seem to aggravate eczema, possibly by suppressing mast cell function).

Clearly there are health and safety issues that need evaluation, and hopefully the FDA will take these under serious consideration. But perhaps one of the biggest public health concerns associated with triclosan involves the strong possibility that widespread use of this agent may contribute to antibiotic resistance by several mechanisms (including active efflux from the cell, which is a quite dangerous adaptation).

The presence of triclosan in hand soap (as well as in many, many cosmetics, textiles, and other products as mentioned in the list below) can also give people a false sense of security. Consider a kitchen cutting board made with Microban — are you less likely to wash and/or disinfect the board and counter after use?

Yes, triclosan is pretty much everywhere. I expect that list to change somewhat depending on the FDA’s decision. Antibacterial products are, in my opinion, largely a marketing ploy and used far beyond what is necessary for good hygiene.

So what are the alternatives? I believe the answer is the same as it always has been. Wash your hands — just choose better soap.

Handwashing remains a vitally important public health measure for avoiding the spread of respiratory and fecal pathogens. Washing with plain soap and water is better than water alone, because soap decreases the surface tension of water so that dirt and bacteria can be washed away more easily. Scrub your hands thoroughly (click the icon for detailed instructions). Use water of a comfortable temperature because scalding hot water does not get hands cleaner; tepid or even cold water is okay too. Drying hands with a towel helps brush off additional germs, but avoid hand dryers which actually spew more germs into the air. (See the studies cited by the CDC on handwashing).

And never fear, there are plenty of soap brands out there that have not fallen to the “antibacterial” craze. Some of the popular commercially available brands include Method, Mrs. Meyers Clean Day, Dr. Bronner’s castile soaps, and Avalon Organics. (These affiliate links point to, which is one of my favorite online retailers for health and beauty products, but of course you can find these and other soaps at most drugstores). An added bonus of triclosan-free soaps is that they are often also free of parabens and synthetic fragrances which have plenty of their own side effects.

If you are interested in doing more of your own research on soap brands that are better for you and for the environment, the Environmental Working Group maintains a great database called “Skin Deep” which rates soaps, cosmetics, sunscreens, and other skincare products based on the current data available. Click here to search for liquid hand soaps free of triclosan and triclocarban. Or try out the new EWG Skin Deep mobile app the next time you’re at the store!