This is an issue that comes up regularly and also very early in any conversation about atopic dermatitis. Just like any other question, it requires rational answers but it also triggers other, irrational questions. We’re going to look at both.
The rational part involves a number of practical questions:
• Do detergents cause atopic dermatitis? No, no, and no again, atopic dermatitis is caused by dry skin acting as a sponge instead of acting like cling film.
• Do detergents exacerbate dry skin? The answer really ought to be no, but in fact it’s possible that this is not the case. In theory, the rinse cycle should be enough to remove all traces of detergent. In practice, however, it is highly likely that rinsing is not 100% effective, the proof being that if your washing still has a fragrance, there is still some detergent in it.
• How does detergent exacerbate dry skin? Just like all chemicals, it has a corrosive, or caustic, effect. Which is why, as a general rule, it’s best to get rid of any useless chemicals in your bathroom. Don’t forget that atopic dermatitis is a modern disease, and that in today’s world chemicals play too big a part.
• What can be done? Two complementary things can be done: use less detergent when washing, half as much is plenty, and run two rinse cycles.
• Are some detergents harsher than others? It’s better to avoid dry washing powders and highly perfumed detergents. As for Savon de Marseille soap flakes, they don’t remove all stains.
• What should we think if a product has the label ‘hypo-allergenic’? This label does enormous damage by making people think that atopic dermatitis is caused by an allergy and that allergens should therefore be avoided. This is completely untrue. Confusing the words allergic and inflammatory is the first obstacle to understanding this disease, and it is extremely regrettable that the cleaning products industry does not take into account the difficulties faced by our patients when trying to navigate this maze. A label saying “Atopic skin friendly detergent” would be much more helpful.
• Should fabric softener be used? Definitely not – again, it’s just another totally useless chemical. People who prefer a softer feel to their washing can use white vinegar and laundry balls instead.
• Should washing be done by hand? It’s fashionable at the moment but it is a lot of work for very little reward.
This really is not what’s at the heart of the problem.
The irrational part is elsewhere: why does this question keep coming up so often during consultations when its real impact is such a small part of managing the disease? a few thoughts:
• There is always this illusion that atopic dermatitis is caused by just one thing, one factor, and that if it could just be found then the problem would be solved. While this may be true for contact eczema, for atopic dermatitis it is not the case. The confusion continues to reign because of the various forums mixing allergy with inflammation, when in fact they are not at all the same thing.
• But the true underlying obstacle is that it’s far easier to buy a different detergent than to apply a cream every single day of your life. Patients can only be persuaded to change their habits when they understand how their skin works and what they need to do to protect it, and they see the benefits on a daily basis. Obviously, applying an emollient every day doesn’t solve every problem, but not doing so means there is no chance whatsoever of seeing any improvement.