ALTERATIONS IN THE SKIN PHYSIOLOGY 3 XIV. The program for this, our Tenth December Meeting, sets a new high in technical quality. Under the chairmanship of Gabriel Barnett, who has written all over the country to get the best men in each field, a panel of outstanding speakers has been set up that future years will find it hard to pass or equal. In closing, it has indeed been fortunate to have such a team of able, will- ing workers who have made the hard tasks easy and who were never afraid to tackle new problems. Listed below are a few who deserve special credit for the time and thought which they have given to your SOCIET¾'S problems. James H. Baker George G. Kolar M.G. deNavarre Gabriel Barnett Robert A. Kramer Edward Sagarin William Colburn Paul G.I. Lauffer Sabbat J. Strianse S. F. Coneybear Edward P. Morrish Walter A. Taylor William R. Giese Everett G. McDonough Walter Wynne There are many more who helped quietly and steadily. Your incoming president is indeed fortunate to have such a group of able, willing workers, and your outgoing president will miss the many pleasant hours spent with them. ALTERATIONS IN THE SKIN PHYSIOLOGY FOLLOWING CONTINUOUS USE OF SOAPS AND DETERGENTS* By DONALD J. BIRMINGHAM, M.D. Chief Dermatologist, Occupational Health Field Headquarters. U.S. Public Health Service, Cincinnati 2, Ohio DERMATOLOGISTS and others interested in the physiology of the skin have long sought a complete explanation of the cutaneous alterations brought about by the use of soaps and detergents. A wide range of accu- mulated clinical and laboratory information can be theoretically and fac- tually applied to the problem, but there has yet to be developed a logical explanation of cause and effect relationships. Despite this lack of definition, there is one point upon which all investigators are likely to agree, namely, that no one factor is wholly responsible for the cutaneous changes suspected as being caused by detergent preparations. Indeed, the current scientific literature strongly suggests that the explanation of this problem will prob- ably rest upon determining how and to what extent keratin, sweat, pH, water * Presented at the December 9, 1954, Meeting, New York City.

4 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS diffusion and retention, sebum, C02 diffusion, and possibly enzyme systems are influenced by external contactants such as detergents. While the physiology of the skin is by no means completely understood, several outstanding contributions in the past fifty years have clarified many of the complexities concerning its structure, function, and reactivity. These data have become standard references for dermatologic investiga- tions, because they contain invaluable background information which will help to explain the cutaneous alterations believed to be attributable to soaps and detergents, among other common contactants. The purpose of this presentation, then, is to review some of the knowledge which has contributed to a better understanding of the physiologic response of the skin to the action of soaps and detergents. Dermatitis caused by detergents of natural or synthetic nature is the result of either low-grade primary irritation or specific sensitization, or at times a combination of both. Most investigators in this field believe that the irritant effect is the most common mechanism and that allergic contact type sensitization is relatively infrequent. This belief has been borne out by the observations of Lane, Blank, Burckhardt, Pluss, Johnson, Kile, Kooyman, and others. Further recognition and acceptance of the primary irritant effect as the major mechanism has been brought about by the use of the patch test. Properly performed patch tests with soaps and detergents have repeatedly demonstrated that specific sensitization to these agents is by no means a common occurrence. It is well established that the primary irritant can injure the integument, but how can we apply this premise to the chemical action of detergents upon the skin ? When irritants contact the human skin so as to alter its physi- ology in one or more ways, the resultant conditions are manifested by cer- tain subjective and objective phenomena. Subjectively, there may be a sense of tightness, dryness, drawing, burning, tingling, itching, or even pain of the affected parts. Objective phenomena or signs as distinguished from subjective symptoms can be readily observed. These include redness, dry- ness, scaling, fissuring, swelling, vesiculation, and sometimes widespread eczematous response. The severity of response usually parallels the con- centration of the irritant and the duration of exposure. All of these physio- logic alterations can be associated with the action of soaps and synthetic detergents, but it is more common to observe redness, dryness, and scaling than to note the more severe effects such as fissuring, vesiculation, or wide- spread eczema. As a group, cutaneous irritants of organic or inorganic nature can be classified according to their effects as follows: 1. Fat removers. 2. Sweat neutralizers.