The Current State and Orthodoxy of Atopic Dermatitis
To clarify what atopic dermatitis is, the numbers of people it effects and current thinking on the condition, here's an excerpt From the American Family Physician dated September , 1999
entitled Atopic Dermatitis: A Review of Diagnosis and Treatment
"Atopic dermatitis is a common, potentially debilitating condition that can compromise quality of life. Its most frequent symptom is pruritus (itching). Attempts to relieve the itch by scratching simply worsen the rash, leading to a vicious circle. Treatment should be directed at limiting itching, repairing the skin and decreasing inflammation when necessary. Lubricants, antihistamines and topical corticosteroids are the mainstays of therapy. When required, oral corticosteroids can be used. If pruritus does not respond to treatment, other diagnoses, such as bacterial overgrowth or viral inventions, should be considered. "
"Atopic dermatitis is a chronic inflammation of the skin that occurs in persons of all ages but is more common in children. The condition is characterized by intense pruritus and a course marked by exacerbation and remissions. Atopic dermatitis has been reported to affect 10% of children in the United States alone it is estimated that more than $364 million per year is spent on the treatment of childhood atopic dermatitis. Although the symptoms of atopic dermatitis resolve by adolescence in 50% of affected children, the condition can persist into adulthood. Poor prognostic features include a family history of the condition, early disseminated infantile disease, female gender and coexisting allergic rhinitis and asthma."
What did we learn from the above? That doctors really don't know the cause, that they don't have a cure, that it is often misdiagnosed, that powerful drugs (corticosteroids, steroids? - isn't that the stuff that got all those baseball players in trouble?) are often prescribed, not to cure but to lessen the itching. The article is from 10 years ago but the majority of dermatologists today still believe the above. As far as the annual cost of treating atopic dermatitis, $364 million (even for treatment of children only) was greatly understated. In a handout put out by The National Institute of Arthritis, Musculoskeletal and Skin Disease last year, they estimated direct cost of total (not just kids) atopic dermatitis (doctor and hospital costs) treatment was estimated to be around $3 billion and this was just 25% of total costs. Indirect costs, (filling prescriptions, etc.) accounted for 75% of the cost so that's another $9 billion or a total of $12 billion. This too greatly understates the true cost of atopic dermatitis when considering the lost time at work by people who suffer from this condition. It is a problem, especially when you consider atopic dermatitis is only a symptom of something gone wrong in the body. Atopic dermatitis is often accompanied by other physical problems such as allergies and asthma. What is the cost when you throw in these physical ailments?
Don't get confused by the myriad of information you see on the Web. Here's one from MedicineNet.com. which is better than most of the kinds of descriptions you run into in the popular press.
"Multiple factors can trigger or worsen atopic dermatitis, including dry skin, seasonal allergies, exposure to harsh soaps and detergents, new skin products or creams and cold weather." OK, not wrong but two things to question about this statement. 1.) What causes "dry skin" and 2). the word "harsh" to describe soaps and detergents. Again, dry skin is caused by surfactants, in most instances. Moving on, the word "harsh" needs to be questioned because this implies there are alternative choices that are available. Perhaps there are products containing "less harsh"surfactants that may relieve the symptoms for some for a period of time, may even delay the onset of the symptoms for others but in the end, if the product contains a surfactant, the chances are you or somewhere down your generational line, one of the offsprings of your offspring, will eventually get atopic dermatitis. Either that or your body will learn to adapt. In addition, you can find testimonies by doctors saying only about one out of 100 cases of atopic dermatitis is related to the soap products that are used. This just doesn't correspond to what we know.
The above information is either outdated or just plain wrong as you can see on a web page titled, Skin Therapy Letter (Cutaneous Cleansers) - "Written for dermatologists by dermatologists" in the section subtitle "Effectiveness/Recent Findings" published in 2003. You will find the following:
"Surfactants cause the majority of adverse skin reactions and disrupt or disturb the moisture skin barrier as surface debris and microorganisms are removed. Anionic/sodium containing surfactants such as sodium lauryl sulphate, sodium tallowate and sodium stearate have been shown to disrupt lipids in the moisture skin barrier, as well as increase the PH of the Skin by as much as 2-3 units. Disruption and depletion of barrier lipids and an increased skin PH leads to compromised skin barrier leaving the skin in a negative physiologic state with an increased sensitivity to potential irritants.
Other surfactant types, i.e. amphoteric (cocamidopropl betaine) and nonionic (propylene glycol) have been shown to cause a range of skin and sensory irritations."
Japanese Doctor Cures all 651 Atopic Dermatitis Patients
So the above is in agreement with a very comprehensive study done with atopic dermatitis patients. A dermatologist in Japan, a Dr. Yoshinari Isobe treated 651 Japanese atopic dermatitis sufferers and within two years, cured them all. How? By telling them to avoid all surfactants. They were not allowed to use any soaps, shampoos and avoid all surfactant-containing personal care products and bathe using lukewarm water only. The severity of atopic dermatitis ranged from relatively minor to severe in both female and male patients, and ages of the patients ranged from infants to the very elderly. The time from initial consultation to cure ran from a few weeks to two years. 80% of the cases were cured within 500 days. The remaining 20% took longer due to exposure to oil, cement, special dyeing chemicals or resins in their work. Others that took longer suffered from "sick-house syndrome", those spending much of their time in a living environment which included excessive amounts of polyester and polyurethane chemical fibers. Dr. Isobe writes, "I have concluded that the continuous daily usage of detergents such as shampoo, rinse and body soap lies at the bottom of this chronic problem".
In this study, Dr. Isobe makes some interesting observations:
1. The real breakout of atopic dermatitis began in the mid 1970's with growth in Japanese income and increased use of shampoos, conditioners and body soaps.
2. People who are not accustomed to using surfactant based soaps, like the Tibetans, Mongolians and Eskimos have had no incidences of this illness. (Really?)
3. Symptoms of atopic dermatitis has in recent years been detected in household pets, mainly dogs, that are kept indoors and washed with surfactants by their owners.
While both the "Skin Therapy Letter" Web page and Dr. Isobe seem to agree on the major cause of atopic dermatitis, I think the "Skin Therapy Letter" advice on using safer surfactants to wash is bad and wonder where these dermatologists get their information - from sales representatives of expensive soap formulas, perhaps.
"Liquid facial cleansers are the most effective and beneficial cleansers for sensitive and compromised skin. Their formulations are complex, utilizing a combination of surfactants, moisturizers, binders and preservatives to form a product that will cause the fewest problems and the greatest benefits. A well-designed liquid facial cleanser will use nonionic and silicone surfactants....."
Does the above sound right to you? Use a soap that has even more chemicals in it to cure the problem caused by chemicals? Anytime a sales pitch starts with "Well its complex...." I get the feeling they are saying don't worry about it, let the experts figure it out for you. And usually if you let someone else do your thinking you end up putting yourself in a bigger mess. The conclusion is a definite red flag:
"Although liquid facial cleansers are formulated to be less irritating to the skin, some of its components may disrupt the skin barrier or cause contact sensitivities." I've heard enough, no thanks. I'm pretty sure Dr. Isobe would not recommend replacing one surfactant with another.
Dr. Isobe is attempting to get his study printed by a major medical or science journal in English. He also has a book out in Japanese that may one day be available in English.
Exposure to Surfactants from the Clothes you Wear
Unfortunately for my purposes, which again is to get laundry detergent makers to stop using surfactants, Dr. Isobe did not write about the effects of the surfactants that remain on your clothes after washing. As long as you wash with detergents containing surfactants you will always be exposing your body to the surfactants that stays on your clothes. Even after 2 rinses, studies have shown as much as 30% of the surfactant is still stuck to your clothes. According to the inventor of the surfactant-free detergent, even after switching to the healthier stuff, it would take approximately 5 washes in the surfactant-free formula to get all the accumulated surfactants out. While most toxicity research on surfactants warn, can be absorbed through the skin, I think you might be better off health-wise to think, all surfactants are absorbed into the skin, no matter how minute.
As all drug companies and some ex-smoker's realize, a drug patch treated with the right conductor chemical is a great way to release drugs into your blood stream, it's quick and releases the drugs at a constant rate. The nitroglycerin in the tablet placed under the tongue of a person in the initial stages of a heart attack will reach that person's heart in 13 seconds. Sodium lauryl sulfate (SLS) a surfactant still found in many shampoo formulas is a great conductor of drugs through the skin barrier. Its been found to be in the bloodstream as quick as 3 seconds after application. In consideration of recent findings in surfactant research, the danger of dermal toxicity posed by surfactants remaining on your clothes is real and must be taken seriously. A chemical compound that can penetrate the skin barrier and mutate your genes shouldn't be found in the fabric of your jeans.
While people suffering from atopic dermatitis has probably existed from the time man began using soap (Sumerians are credited for making the first soaps around 2,500 BC), the epidemic really started from around 50 years ago and the incidences of people suffering from this skin illness continues to increase throughout the developed world. The cleaning and personal care industry must reduce their use of surfactants and it is up to consumers to instruct them to do so. Without hearing from you, nothing will change except the numbers of people undergoing treatment for atopic dermatitis.