Dermatologists Have a Dirty Little Secret

Most Americans view soap as essential to bathing as water. The daily grind confronts us with dirt, germs, and sweat, and a soapy shower provides the simple, pleasurable antidote.

Uncontroversial though soap may seem, some people are very troubled by your sudsy lather: dermatologists. “If you talk to most dermatologists, probably none of them use actual soap, except on their hands,” says Dr. Erin Chen, herself a dermatologist at Massachusetts General Hospital. 

Here’s what Chen and four other experts say about avoiding soap, healthier substitutes, and tips to make sure your cleaning rituals aren’t accidentally undermining your skin health.

The many downsides of soap

Soap rubs skin the wrong way for several reasons. It “contains many ingredients that just don’t do well for the skin,” says Dr. Anthony Rossi, a dermatologist at Memorial Sloan Kettering Cancer Center.

Soap combines fats or oils with sodium hydroxide (in the case of soap bars) or potassium hydroxide (for liquid soap). These ingredients are very effective at breaking down dirt—too effective, in that they cause irritation and damage to the lipids that keep the skin strong and hydrated, Rossi says.

A study in healthy volunteers showed that washing with soap disrupts the skin barrier, and the more times soap was applied and rinsed while cleaning, the more disruption occurred. Such affronts lead to dry skin, sensitivity, and increased risk of infection, says the study’s author, David Voegeli, an immuno-pharmacologist and nursing professor at the University of Winchester in England.

The study also showed that soap changed the skin’s acidity. This happens because soap has a lower acidity level than the skin, and the mismatch upsets the skin’s pH balance. Soap may be especially problematic if it’s not rinsed off thoroughly, which is more likely with bar soap than the liquid variety. “The residue just stays there and disrupts the pH balance for longer,” Voegeli says.

Read More: 12 Weird Symptoms Dermatologists Say You Should Never Ignore

Changing the pH level has a domino effect because “pH is also really important for the skin’s microbial defense,” Rossi says. A related problem is that soap’s chemicals clear out the bacteria from our skin. Nice as that may sound, many such bacteria are actually key to protecting skin health. 

Many soaps contain yet more chemicals that have nothing to do with cleaning and everything to do with creating a fragrant facade of cleanliness. These fragrance chemicals, while psychologically pleasing, can lead to irritation and allergies. “You would never tolerate perfume or scent in your eye drops,” says Dr. Rachel Nazarian, a dermatologist at Mt. Sinai Hospital. “Why do we disrespect the skin by putting all of this flowery, fluffy garbage in soap?”

Use this instead

Instead of daily soap-downs, dermatologists prefer skin cleansers. Compared to soap’s harshness, many cleansers have milder ingredients that achieve sufficient cleaning without overdoing it.

“Cleansers have a pH that matches the skin, and they don’t strip the whole barrier off the way old-school soap does,” Nazarian says. In a 2021 study, German researchers found that the frequent use of skin-friendly cleansers during handwashing caused no impairments to the skin barrier.

Even with cleansers, it’s important to choose the right ones and avoid overuse, Nazarian adds. Some of them have better pH levels than others, she says; people should look for the cleansers with “pH balanced” written on the label. The company Cetaphil, for example, makes several cleansers—each of which is better than soap, every dermatologist we spoke to said—but you want to opt for versions with less foam, Nazarian says. Foamy cleansers can be abrasive (while still preferable to soap). Ingredients to watch out for that cause foam are sodium lauryl sulfate and cocamidopropyl betaine, Rossi says. Test new cleansers on your forearm to ensure the ingredients won’t cause a reaction.

Read More: Do Pimple Patches Actually Work?

Beside foaming ingredients, some cleansers have other red-flag ingredients that could cause allergic reactions, Rossi says. Examples are fragrance mix I and II. Be cautious, too, with formaldehyde-releasing preservatives like benzylhemiformal. Dr. Shilpi Khetarpal, a Cleveland Clinic dermatologist, suggests looking for cleansers certified by the National Eczema Association. “They’re safe for everyone to use,” Khetarpal says, while noting that “too much of anything can be detrimental.” 

Other gentle cleansers are made by CeraVe and Aveeno, she says. 

As for body washes: most are cleansers, but some are soaps. The terms soap and cleanser are sometimes used interchangeably—but not by dermatologists. Effective cleansers may come in bar form, such as Dove Sensitive Skin, but “this is not soap,” Nazarian says. Khetarpal prefers the bar form of cleanser instead of body wash. 

But even cleansers should be used sparingly, some dermatologists think. When using a cleanser, you’re probably doing enough to counter dirt by just specifically targeting the smellier areas—armpits, groin, and feet. Nazarian uses an unscented cleanser in these areas only during her daily showers (in addition to shampoo). “You don’t need to cleanse the whole body,” Nazarian says. She thinks that shampoo suds running down the body clean effectively without requiring much else. “Suds do a nice, basic cleaning of bacterial sweat.”

Meanwhile, Khetarpil uses her non-soap cleanser over the entire body. 

The hand exception

Dermatologists like Nazarian make an exception for soap when it comes to handwashing, as opposed to showering. After constant contact with other people, subway poles, bathrooms, and other dirty surfaces, “more intense germ removal is sometimes needed,” in which case it’s recommended to reach for soap when washing hands, Nazarian says. 

The hands can handle soap’s strength better because the skin there is “much thicker, so it’s less prone to drying out from washing,” than most other parts of the body, Chen explains.  

Sometimes water suffices

Deploy cleansers in the shower when you’re noticeably dirty, but not daily, Chen says; water is enough for cleaning most of the time. Rossi agrees: “The natural lathering of water is going to get rid of most of the bacteria on your skin.” 

This approach dovetails with the hygiene hypothesis: some scientists believe that, in recent decades, an overage of skin cleaning has reduced people’s beneficial bacteria too much, leading to upticks in allergies and infections. “We’re too clean,” Rossi says, so the immune system is less capable of fighting parasites.

Read More: Are ‘Broken Skin Barriers’ a Real Thing?

Dermatologists like Rossi think people can skip showers altogether, multiple days per week. This view isn’t unanimous, though. Khetarpal advises that most people “can and should shower every day,” particularly if using mild cleanser instead of soap. Only those with sensitive or eczema-prone skin should think about skipping shower days, she says. 

Don’t get yourself in hot water

Perhaps the ultimate one-two punch against the skin’s defenses is soap and hot water. Even when using a gentle cleanser or just water, the skin suffers with excess heat. Thirty-minute steamy hot showers “can’t be a daily thing,” Nazarian says. “You’re going to destroy your skin that way.”

Hot water strips away the body’s natural oils, causes water loss within the skin, and damages the skin’s outer layer so it retains less moisture, research shows. Inflammation and flakiness may result. 

Navarian compromises with patients by conceding hot showers as an occasional treat. “Save them for when you’re having a really bad day.” Another acceptable approach is enjoying hot water only for the final 1-2 minutes of your shower, she adds. The rest of the time it should be lukewarm, around 98-100°F.

Read More: The Healthiest Way to Clean Your House

Whether you’re using soap or cleanser, never combine them with a loofah or other physical exfoliant. “The only parts of your body that can probably handle a physical exfoliant are the heels of your feet,” Nazarian says. She advises using a very gentle wash cloth instead.

Post-shower, don’t get carried away with vigorous toweling. “The rougher your towel, the more skin you’re going to strip off,” Voegeli says. Instead, dab yourself dry.

Application of a good moisturizer after showering can help, Nazarian adds. “If people use moisturizer immediately after getting out, they can buy themselves a little more flexibility with how they cleanse, with less skin punishment.” Chen emphasizes the use of a post-shower emollient moisturizer like Vaseline to help repair skin barrier function and improve appearance, noting it’s especially important if you’re showering daily. “Most people need a little assistance to replace their skin’s lipids after showering,” she says. 

Take particular care if…

Older people may be more vulnerable to the effects of overcleaning, Nazarian points out. This is particularly true of menopausal women, for whom hormonal changes typically create a drying effect on the skin. 

Those with dry skin should take extra care in avoiding harsh soap and heeding related tenets of shower hygiene. “If people haven’t learned the lessons of skincare by their 40s, they’ll pay for it in their 60s,” Nazarian says. 

Another individual difference: frequent exercise with profuse sweating may create the need for more cleaning. “If you’re exercising and sweating a lot, you’re going to want to clean that off, because eventually it’s going to build up and cause some odor,” Rossi says. You’ll still want to use a cleanser, though, not soap.

Nazarian is less concerned by lots of sweating than regular skin-to-skin contact with others. “That’s my exception” warranting more self-cleaning, she says. If you regularly work out at boxing gyms or practice martial arts, for example, “you need a little more cleaning” to wash away infectious strains of bacteria picked up from others, she says. Again, cleansers are your best weapon. 

However, Nazarian adds that skin is less susceptible to these pathogens if it’s healthy —and undamaged by soap. Dermatologists may debate the finer points but tend to agree on the virtues of a gentle cleanser, thinning down the rationale for anything else to a soap sliver.