COSMETICS VERSUS TOPICAL THERAPEUTIC AGENTS 437 dermatologists and cosmetic manufacturers. Mineral oil or some other oily anhydrous material is occasionally used for cleansing diseased skin. Cleansing creams and baby oils are among the agents advocated for normal skin by cosmetic manufacturers and sometimes by dermatologists. Most cleansing creams contain small amounts of water, but many baby oils are anhydrous both are recommended for use without additional water, on the assumption that water and a mild cleanser might be injurious to the skin of the infant or the face of the adult. It is likely, however, that the judicious use of water and a cleanser does not injure normal skin or some abnormal skins and that, in fact, this more efficient type of cleansing may be beneficial if not repeated too frequently (10). Currently, most shampoos are formulated from synthetic, anionic surface active agents. These substances are excellent cleansing agents in both hard and soft water indeed, they often clean so well as to make the hair temporarily "unmanageable" after a shampoo, so far as grooming is con- cerned. Such removal of sebum probably does not damage the skin of the scalp, but it may loosen flakes of the stratum comeurn and thus make "dandruff" more apparent. 4. ,4ntimicrobial Preparations Antimicrobial substances are used topically by the physician for both prophylactic (surgical scrub, preparation of the surgical field) and thera- peutic purposes. They are incorporated in cosmetics as deodorants and as a means of combating the micro6rganisms thought to be involved in seborrheic conditions. Antimicrobial agents may be either bactericidal or bacteriostatic in their action. The bactericides kill viable organisms rapidly and directly the bacteriostats prevent their multiplication without killing them. Since the life span of a single, nonsporulating micro6rganism is short, a population of these organisms will eventually be destroyed by any substance which prevents their multiplication. At the present time, alcohols and antibiotics are the bactericidal agents most commonly used in both cosmetic and pharmaceutical preparations. Alcohol has a wider spectrum of activity than do the antibiotics (11). Hexachlorophene is probably the most commonly used bacteriostatic agent. Antibiotics are incorporated into both ointments and lotions, bacterio- static agents into ointments, lotions and cleansing preparations. Sub- stances like hexachlorophene are effective when incorporated in cleansers because they are substantive to the skin (12) and are deposited on the skin in small amounts during the cleansing process. For prophylactic use, surgeons and dermatologists have found that topical antimicrobial agents are quite satisfactory for the treatment of cutaneous disorders known to be of microbial origin, on the other hand,

438 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS these agents are less satisfactory. There is an increasing tendency to use systemic rather than topical therapy for these disorders. The exact pathogenesis of neither mild seborrhea (dandruff) nor mild acne is yet known, and it remains to be shown whether bacteria play an important role in the pathogenesis of these disorders. Control of bacteria by topical antimicrobial agents may therefore not affect the course of these diseases. There can no longer be much doubt that the control of bacterial multi- plication on the cutaneous surface will diminish and alter body odor. The use ofantimicrobial agents in deodorants is therefore well justified. 5. ztntiseborrheic ztgents The two so-called seborrheic disorders for which cosmetics are marketed are dandruff and ache. To counteract dandruff, antiseborrheic agents are incorporated into both hair lotions and shampoos. Various lotions and ointments are available for the treatment of "adolescent pimples" (mild ache). Since neither the specific etiology nor the pathogenesis of dandruff and ache is known, one can hardly speculate about how antiseborrheic agents act upon these conditions. Sulfur is commonly used as an antiseborrheic agent. Selenium sulfide, zinc pyridine thione and other agents have been added to shampoos in recent years and recommended for the control of seborrhea of the scalp. The specific mechanism of action of these agents is controversial, and there is a dearth of good clinical data to prove that all of them control seborrhea or "cure" dandruff or ache. 6. ztntiperspirants Antiperspirants, such as aluminum salts, are used for the most part to control the delivery of sweat to the cutaneous surface of the axilla. Differ- ences of opinion currently exist as to whether or not topically applied antiperspirants do effectively reduce sweating. It is difficult to obtain reproducible data on the delivery of sweat. If antiperspirants are effective, the duration of their effectiveness after application may depend on en- vironmenta! conditions, psychic stress, nu.mber of previous applications, etc. Since most of the sweat in the axilla is produced by the eccrine glands, an effective antiperspirant might be expected to reduce the activity of these glands. Just how this can be accomplished by a topically applied substance is not clear. The physician is not infrequently asked to help control hyperhidrosis of the palms and soles. The antiperspirants used in cosmetics are rarely, if ever, effective for this purpose. Solutions of formaldehyde may be helpful (13), although irritation may follow their use. The mechanism of action of formaldehyde is not known.