HAS MILDNESS REPLACED CLEANLINESS NEXT TO GODLINESS

Over the past 30 years we have witnessed a change in our approach to soaps. The turning point was, in fact, the publication of an article by Frosch and Kligman in 1979, in which they described a new method for assessing the irritancy of soaps. They maintained that the chief weakness of the usage tests in the past was that the reactions under normal usage conditions were weak and did not discriminate adequately between different soaps. They proposed a test, called the soap chamber test, which was conducted under extreme conditions, on people known to have a sensitive skin, thereby resulting in strong reactions that emphasized the slight differences between the various soaps. Frosch and Kligman's work opened up a whole new era in the field of assessment of soap quality. Following their initial studies, many other studies were conducted, including the exaggerated use tests, often in conjunction with instrumental methods of evaluation, such as measurement of transepidermal water loss, electrical conductance, skin color and blood flow, and other tests designed to evaluate the irritation potential of various soaps. All those tests had a common purpose: to achieve extreme conditions which would provide greater sensitivity and discriminating power and would accentuate and emphasize the differences between soaps as much as possible: the greater the discrimination and the differences between the products, the more efficient and useful the test. The introduction and publication of tests such as those completely changed our approach to soaps. The sought-after qualities in a soap became safety, mildness, gentleness, less irritation, less drying - in particular, gentleness and mildness were emphasized. Rather surprisingly, the soap's main purpose - cleaning the skin - was set aside; people no longer talked of the soap's most important quality - skin cleansing. Is the above change in approach justified? What really constitutes a good soap? Which soap should we recommend to our patients? Is a soap that scored well on irritancy tests under extreme conditions really the best soap? It seems to me that it would be a mistake to ignore all the accumulated clinical experience in favor of new, modem testing methods. A balance must be found between new information resulting from modem testing methods, and clinical experience that has proven itself over years.