Piercing Aftercare - Is Germicidal or Anti-microbial Soaps Needed?

Do you really need to use an antiseptic, Germicidal, Anti-Bacterial or Anti-Microbial Soap to heal out a Body Piercing? It's a question that has come up time and time again over the last decade or so. In this installment of my series on Body Piercing Aftercare Products, I felt it was important to address that questions before reviewing three of the most commonly suggested products Dial Gold Anti-Bacterial Liquid Soap, Provon Anti-Microbial Liquid Soap and Satin Satin Therapeutic Skin Cleanser.

At the bases of every aftercare program is taking additional steps to prevent the open wound aka piercing from becoming infected. The first line of defense is cross-contamination prevention and it's why that we ask that you take steps during the healing period to limit activities that would increase the risk of exposing the healing piercing to foreign pathogens. Not only limited contact with possible contaminants like body fluids, bodies of water, unclean bedding, bodily fluids, unclean clothing, etc... but also to take steps to reduce the risks by washing hands and cleaning your environment. However, is this enough?

Though we would like to believe that all of our clients follow our instructions until the piercing is healed but I feel the reality is much different. Your average person will make mistakes and will contaminate the area without even realizing it. It's easy to blame it on laziness or misinformation. However, it comes down to the simple fact that most of the average public has not developed the habits of cross-contamination, will make mistakes and are not used to having an open wound on their body for up to a year in some cases.

The average person will heal a cut or abrasion within 1 to 2 weeks and during most of that healing period, it is not a completely open wound in the way a piercing is. The whole nature of a piercing is keeping the wound open with a foreign object. The longer the period that the wound is acceptable to contamination, the higher the risk. The reality is that within even an 8 week healing period, your average person is not only going to contaminate the piercing area but more than likely a number of times.

There are those that would say that a healthy person with an uncompromised immune system should have no problem fighting off a large number of foreign pathogens. I believe that to be true and it makes sense that in most case of contamination the body's own immunity should be enough to fight off an infection. The thing is that if that was the case, no piercing would ever become infected and that is not the case. 

So, is it only lazy people that have piercings that become infected? Maybe they just aren't as smart as the rest of us or aren't as healthy as the rest of us. Wrong, though I rarely see infected piercings, when I have in the past it has been on clients that were intelligent and seemed healthy. Often they have no clue or are unwilling to admit what action or inaction led to the infection. Those that do openly admit to the cause it is usually a case where they thought a small amount of exposure to contamination wouldn't be that big of a deal or they completely stopped using the cleaning the piercing with an anti-microbial soap after a few weeks. I have even had clients that just stopped using the soap in favor of a saline spray only approach, develop infections.

So, what is going on in those that get infections? They are being exposed to a pathogen that their immune system can not fight off. Even though they are cleaning the wound with saline, which regardless of what saline sprays may claim, have a limited effect when it comes to being an antiseptic. What is causing the infection is exposure to new pathogens that their body has not built up immunity to or the immune system is overstressed. So, the piercee makes a mistake, the piercing area is contaminated and low and beholds you have an infection. Too bad there couldn't be an additional step that could limit the exposure and population of foreign pathogens in the piercing are. Well, there is, it's called cleaning the area daily with an antimicrobial solution.

The other main advantage to cleaning the area on a regular base is that it reduces the population of pathogens and thus reduces the amount of work the body has to put into fighting off infection. The bonus is that the body can focus on healing the piercing and thus a faster healing period. It has been proven in a number of studies that cleansing the wound with saline combined with antimicrobial or germicidal substance has seen faster healing, recovery and when infection occurred a reduction of the spread of the infection.

You may be asking yourself, then why has there been an increasing number of piercers dropping soaps from their aftercare instructions? I've been asking myself the same question and from what I've gathered it is two main things. A push toward "Natural" Piercing Aftercare Products, unwarranted fear of chemicals, a belief that soaps dry out the piercing, the effect they calm the soaps have on probiotics and trying to make aftercare easier for clients. 

Before we get pulled off subject with a wonder to the woods and a long boring diatribe about the healing powers of mother earth, let's make it clear that the uses of the word "natural" in many of these products are nothing more than marketing. The ingredients in all of these products are refined a great deal from their natural state through the magic of chemistry. Just because something comes from nature doesn't mean that it is any safe than any product created in a lab. In fact, unlike most chemicals on the market that have been extensively tested, most "Natural" products have not been scientifically studied for harms or effectiveness.

The other issue with natural products is since there is very little regulation on these products, they often add additional ingredients to make sure that the product does what they claim it is doing. I recently, as in today, stopped suggesting Grapefruit Seen oil based products. In an independent study on the anti-bacterial effectiveness of GSO products, it found that those that were effective contained GSO that was bounded with benzethonium chloride. Those without the extract being bounded with benzethonium chloride were not. So, it was the benzethonium chloride that was, in fact, killing the germs not the "Natural" power of Grapefruit Seed Oil. I'm sorry to all of you that spent an additional $3 to $5 more for a product that had the same effect of a much cheaper product. 

With body piercing aftercare products most of the natural ingredients are food preservatives with little or no independent research on their effectiveness or use as an antiseptic. Often they are hiding under chemical names on the packages and are in fact animal products. For more on this read my blog on H2Ocean.

There has been a number of studies that have come out about the overuses of anti-bacterial products. Warning that overuse could cause health issue, reduce users immunity to bacterias and also cause super bacteria to evolve. Triclosan based soaps where commonly suggested for aftercare for piercings. When the FDA ban came a few years back, like most of the American public, the piercing community freaked out.

The part of the banned that most people seemed to skim over is that the FDA asked manufacturers to prove that soaps with triclosan were more effective in long-term use than simply washing with soap and water. So, this was a consumer protection issue. The product was making claims that may or may not be true. The ban did not include medical application though. Which is odd, though the idea seems to be that you want an operating room to be more sterile than your kitchen. So, basically they are not saying that it isn't effective but question why you need all that bacteria killing power.

There are studies that showed that there were changes in animal's hormone cycle and muscle uses. However, this would be a much higher exposure than would take place in normal exposure to the chemical, only done on laboratory animals and there is little or no proof that it would have the same negative effects on humans. Just like creating super bacterias, it could happen.

One thing that was stated in the FDA release was that it should not be used internally. The confusing part is that Triclosan is still allowed in toothpaste because it has been proven to reduce the risk of gingivitis. So, there is a belief by many piercers that cleaning the piercing with soap would somehow be internal uses. This may be true if it was suggested that the jewelry is rotated during cleaning like it was widely suggested in the early 1990s. However, that isn't the case. In fact, most piercers suggest a minimum amount of contact of 30 seconds, the area to be rinsed well and not to work the soap into the piercing.

This brings us to Probiotics. You know the good bacteria. The concern is that by cleaning the area with an antimicrobial or germicidal soap that you are killing off the Human Microflora that forms after a wound occurs and helps to fight off infection. We have a large population of bacteria that live on the surface of our skin. Most of these bacterias are not harmful to us or we have built up an immunity to them. Like all organisms, they are naturally competitive and protective of resources. So, when they come in contact with other microorganisms that compete for resources they have counter attacks by producing antimicrobial molecules they produce antimicrobial molecules that change the environment in their favor. They do this by disrupting the communication between the cells of the foreign bodies. That some full-on art of war stuff going on there.

The problem with the probiotics on our skin is that we know very little about them, especially how they interact when the skin is broken. In fact, many of the microorganisms that are considered harmless or even beneficial on the surface of the skin are not once they enter the body and the bloodstream. They are kind of like the friendly neighbor that shovels your sidewalk, yes, he's nice, friendly and helpful but you still wouldn't want to wake up in bed next to him. There have been some interesting studies with bacterial extracts that have produced faster division in skin cells and wound closure. This could lead to major breaks in how we fight off infection and wound care. However, this is not introducing live organisms into the wound.

Now the question is what effect do these soaps have on the Human Microflora? Very little. Understand that we are not suggesting that you bath in an antimicrobial or germicidal soap but to only clean a limited area around the piercing. In most cases, we are talking about an affected area that is much larger than a fifty cent piece. There is limited contact only lasting 30 to 45 seconds before being rinsed under running water. The Microflora colony will quickly repopulate the area. In fact, since there is no competition in the area the colony may spread faster. The risk would be that a foreign pathogen is introduced into the area immediately afterward. However, with proper cross-contamination and since the cleaning of the piercing is done on a regular base, the population of the pathogens will be reduced before there is an issue.

There has always been a belief that the soaps dry out and damaging new skin growth. However, cleaning a piercing with a cotton tip applicator drenched in saline solution and not rinsing off the saline will have the same effect. It's been my experience over the years that using a mild soap free of fragrances and moisturizers and thoroughly rinsing after 30 seconds of contact, doesn't dry the piercing out or cause additional issues. When I have encountered piercings on clients that seemed to be dried out, in most cases they were not rinsing the piercing under running water after cleaning with the soap, where rotating the jewelry, not rinsing after doing a compress or soak or were using some other product like Bactine, Hydrogen Peroxide or Rubbing Alcohol.

Dail with Triclosan was the most commonly suggested anti-bacterial soaps. After the ban on Triclosan, Dial replaced Triclosan with 0.10% of Benzethonium Chloride. Most of the claims that Dail can damage healing cells, dry out the piercing, increase crust, etc... were based on issues with Triclosan. Now you may be thinking, gee they replaced one scary chemical with another but we are talking about an externally small but effective amount. When you then add the act of lathering which dilutes the soap, even more, limited the time of exposure, and rinse well after use, the risks are limited. When people often talk about the risks of this chemical or that chemical, they cite studies where massive amounts of the chemical were applied to test animals. Yes, Benzethonium Chloride can be a dangerous chemical if you exposed yourself to large dose but we are talking about an extremely small amount.

In conclusion, I have been considering removing Anti-bacterial, Antimicrobial and Germicidal Soaps from my aftercare instructions. So, I've done a great deal of research to find a non-piercing industry study on wound care and soap, and at this point, I still haven't found anything that is compelling enough to remove it. The advantages of reducing the likelihood of the infection out ways any real risks that I have found. Most of the information that I did find seemed to be more focused on selling a product than pointing out anything conclusive. Almost all the site, studios, piercers and professional organizations that suggested against it, either sell saline based piercing aftercare products or have one of the manufactures listed as a corporate sponsor. Which means that suggesting against the use without any information to back it up has to be taken with a grain of salt.

As I pointed out to a fellow piercer a few years ago, if saline is the only thing needed why not just disinfect the piercing area with saline instead of povidone-iodine? He didn't have an answer. 

Pros:

• Reduces the long-term exposure of piercing to foreign bacterial and pathogens.
• Reduces the risk of infection.
• Keeps the piercing area clear of dirt and debris
• Removes and eliminates salt caking from soaks and saline sprays.
• A second line of defense if the piercee mistakenly contaminates the piercing area.

Cons:

• Exposes the piercing and piercee to harsh chemicals
• If the soap is not lathered up and rinsed properly, can cause the piercing area to dry out.
• May reduce the population of probiotics in the area.
• One of the ingredients may cause allergic reactions
• Overuse of anti-bacterial products may lead to more resistant microorganisms.