Hygiene of the Skin: When Is Clean Too Clean?

Skin hygiene, particularly of the hands, is a primary mechanism for reducing contact and fecal-oral transmission of infectious agents. Widespread use of antimicrobial products has prompted concern about emergence of resistance to antiseptics and damage to the skin barrier associated with frequent washing. This article reviews evidence for the relationship between skin hygiene and infection, the effects of washing on skin integrity, and recommendations for skin care practices.

For over a century, skin hygiene, particularly of the hands, has been accepted as a primary mechanism to control the spread of infectious agents. Although the causal link between contaminated hands and infectious disease transmission is one of the best-documented phenomena in clinical science, several factors have recently prompted a reassessment of skin hygiene and its effective practice.

In industrialized countries, exposure to potential infectious risks has increased because of changing sociologic patterns (e.g., more frequent consumption of commercially prepared food and expanded child-care services). Environmental sanitation and public health services, despite room for improvement, are generally good. In addition, choices of hygienic skin care products have never been more numerous, and the public has increasing access to health- and product-related information. This