Treatment with retinoids, and acne itself, will cause dysfunction of the skin barrier. Facial cleansers also interact with proteins and lipids on the stratum corneum, and may further disrupt the skin barrier. However, acne patients need to use cleansers to control the level of skin oils and microbial levels. It is important to utilize facial cleansers that minimally disrupt the stratum corneum so that the barrier can be preserved. Soaps are alkaline cleansers that increase the skin’s normal pH causing a decrease in the cutaneous lipid content (49). Soaps that contain antibacterial agents (such as triclosan) can inhibit grampositive cocci but increase gram-negative rods (50). The irritant effects of soaps is worsened by hard water (51). Rather than using a soap, patients should cleanse their face with a syndet (synthetic detergent) cleanser. Rather than being alkaline, syndets have a pH close to the skin’s pH of 5.5 (Table 4). Syndets used with hard water do not produce a scum on the skin, as do soaps. Syndets are minimally irritating, and compatible with other acne treatment regimens (52,53). Patients using syndets report more improvement in their acne than those using soaps. Syndets will also aid in minimizing irritation from other acne treatments such as tretinoin (53).
There are cleansers other than syndets may be more irritating but contain superior anti-acne properties. These other products, such as hydroxy acids and benzoyl peroxide, may exist as washes, and also as creams, gels, scrubs, and peels.