Hard water softening effect of a baby cleanser

Walters, Russel M.; Anim-Danso, Emmanuel; Amato, Stephanie M.; Capone, Kimberly; Mack, M Catherine; Telofski, Lorena S.; Mays, D. A.

doi:10.2147/ccid.s111729

Cited by 7 publications

(10 citation statements)

References 30 publications

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“…How much of a contribution to this initial barrier insult is made directly by hard water or indirectly through increased detergent deposition remains unclear. Further complicating the picture, some cleansers may reduce free calcium ion concentrations in water 34 . However, the effect of such calcium‐surfactant complexes on the skin also remains unclear.…”

Section: Discussionmentioning

confidence: 99%

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The effect of water hardness on atopic eczema, skin barrier function: A systematic review, meta‐analysis

Jabbar‐Lopez

Ung

Alexander

et al. 2020

Clin Experimental Allergy

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Background Hard domestic water has been reported to worsen atopic eczema (AE) and may contribute to its development in early life. Objective To review the literature on the relationship between the effect of water hardness (high calcium carbonate; CaCO3) on (a) the risk of developing AE, (b) the treatment of existing AE and (c) skin barrier function in human and animal studies. Design , data sources and eligibility criteria We systematically searched databases (MEDLINE, Embase, Cochrane CENTRAL, GREAT and Web of Science) from inception until 30/6/2020. Human and animal observational and experimental studies were included. The primary outcomes were risk of AE and skin barrier function. Studies were meta‐analysed using a random effects model. Evidence certainty was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Results Sixteen studies were included. Pooled observational data from seven studies on 385,901 participants identified increased odds of AE in children exposed to harder versus softer water (odds ratio 1.28, 95% CI 1.09, 1.50; GRADE certainty: very low). Two mechanistic studies in humans reported higher deposition of the detergent sodium lauryl sulphate in those exposed to harder versus softer water. Two randomized controlled trials comparing water softeners with standard care did not show a significant difference in objective AE severity with softened water (standardized mean difference 0.06 standard deviations higher, 95% CI 0.16 lower to 0.27 higher; GRADE certainty: moderate). Conclusions & Clinical Relevance There was a positive association between living in a hard water (range: 76 to > 350 mg/L CaCO3) area and AE in children. There is no evidence that domestic water softeners improve objective disease severity in established AE. There may be a role of water hardness in the initiation of skin inflammation in early life, but there is a need for further longitudinal and interventional studies.

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Section: Discussionmentioning

confidence: 99%

“…Further complicating the picture, some cleansers may reduce free calcium ion concentrations in water. 34 However, the effect of such calcium-surfactant complexes on the skin also remains unclear.…”

Section: Interpretation Of Main Findingsmentioning

confidence: 99%

The effect of water hardness on atopic eczema, skin barrier function: A systematic review, meta‐analysis

Jabbar‐Lopez

Ung

Alexander

et al. 2020

Clin Experimental Allergy

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“…It is thought that SLS deposition decreases profilaggrin expression, with subsequent reduction in NMF and up-regulation of protease activity [ 45 , 46 ]. An interventional study is ongoing in the UK, aimed at examining whether installation of a water softener before birth is able to prevent skin barrier breakdown and AD development [ 47 ].…”

Section: Community and Regional Environmental Factorsmentioning

confidence: 99%

The Role of the Environment and Exposome in Atopic Dermatitis

Stefanovic

Irvine

Flohr

2021

Curr Treat Options Allergy

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Purpose of review Atopic dermatitis (AD) is a chronic inflammatory skin disorder affecting up to 20% of children and up to 5% of adults worldwide, contributing to significant disease-related morbidity in this patient cohort. Its aetiopathogenesis is underpinned by multiple factors, including genetic susceptibility, skin barrier defects, a skewed cutaneous immune response and microbiome perturbation in both the skin and the gut. In this review, we aim to examine the biological effects of key environmental exposures (the sum of which is termed the “exposome”) at the population, community and individual levels in order to describe their effect on AD pathogenesis. Recent findings It is now understood that as well as considering the type of environmental exposure with regard to its effect on AD pathogenesis, the dosage and timing of the exposure are both critical domains that may lead to either exacerbation or amelioration of disease. In this review, we consider the effects of population-wide exposures such as climate change, migration and urbanization; community-specific exposures such as air pollution, water hardness and allergic sensitisation; and individual factors such as diet, microbiome alteration, psychosocial stress and the impact of topical and systemic therapy. Summary This review summarises the interaction of the above environmental factors with the other domains of AD pathogenesis, namely, the inherent genetic defects, the skin barrier, the immune system and the cutaneous and gut microbiota. We specifically emphasise the timing and dosage of exposures and its effect on the cellular and molecular pathways implicated in AD.

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“…The mechanism underpinning this may involve the reduction of profilaggrin expression induced by SLS 50. Studied water softening techniques have included ion‐exchange and commercially available baby cleansers, although only the former has shown to ameliorate the irritant effects of surfactant 49,51. Further studies are currently underway to assess the impact of softening interventions on AD development and persistence at various time points on the pathogenesis pathway.…”

Section: The Effect Of Specific External Exposures On Admentioning

confidence: 99%

The exposome in atopic dermatitis

Stefanovic

Flohr

Irvine

2019

Allergy

132

103

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Atopic dermatitis (AD) (syn. atopic eczema) is a chronic inflammatory skin condition, affecting up to 20% of children and 5%-10% of adults. 1,2 Current understanding of AD pathogenesis points towards a sophisticated interplay between genetic and environmental factors. The pathogenesis of AD may start in many cases with a genetically predetermined skin barrier defect, which manifests itself as dry skin. This inherent skin barrier deficit leads to an overexpression of pro-inflammatory cytokines and subsequently the activation of innate lymphocyte subsets and antigen-presenting cells (T H 2 and T H 22). IL-4 and IL-13 in particular drive eosinophil and mast cell recruitment and IL-31 secretion, a key cytokine involved in itch sensation. 3 Transcutaneous sensitization to environmental allergens and bacterial infections, in particular Staphylococcus aureus, further contributes to the barrier disruption and eczematous skin inflammation. While a genetic barrier defect is present in many, this is not a prerequisite and many pathological pathways can lead to AD. There

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Hard water softening effect of a baby cleanser

Cited by 7 publications

References 30 publications

The effect of water hardness on atopic eczema, skin barrier function: A systematic review, meta‐analysis

The effect of water hardness on atopic eczema, skin barrier function: A systematic review, meta‐analysis

The Role of the Environment and Exposome in Atopic Dermatitis

The exposome in atopic dermatitis

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