Please Don’t Use Surgical Antibacterial Cleaners as Skin Care | Reviews by Wirecutter

By Rose Maura Lorre

Rose Maura Lorre is a writer who has reported on turkey fryers, composters, body pillows, and more.

Whether you’re battling body odor, razor burn, eczema, ingrown hairs, or back acne, TikTok may have you convinced that over-the-counter antibacterial cleansers containing chlorhexidine gluconate (CHG) are miracle skin-care cure-alls.

In reality, things are much more complicated. Cleansers that contain CHG—such as Hibiclens and Hibiscrub, which are traditionally used to prep a patient’s skin before surgery—have been experiencing a surge of popularity on TikTok. And while they do effectively kill the microbes that can cause some common dermatological issues, they might also give you a nasty rash, impair your skin’s ability to fight infections, or lead to other uncomfortable problems. In very rare cases, CHG may even cause blindness or deafness, if used near your eyes or ears, or result in death due to anaphylactic shock.

Even with those risks, such cleansers continue to be praised as holy grail products by many social media “skinfluencers.” But dermatologists told us that for a lot of patients, this new trend of using heavy-duty antibacterial agents as long-term solutions to common skin conditions is backfiring in ways both big and small.

“Over the past six months, it’s been a little more prevalent,” Dr. Danilo C. Del Campo, a Chicago-based dermatologist and fellow of the American Academy of Dermatology, said in a video interview. “Patients are telling me they’re using this amazing soap they’ve seen all these influencers using, and they’re wondering why their skin is getting worse.”

The truth is, whether you’re looking to treat a specific skin problem or you just want to practice good hygiene to reduce your chances of getting sick, antibacterial products are rarely the answer. Here’s why—and what you should use instead.

Several years ago, a chemical called triclosan was one of the most common ingredients in everyday antibacterial cleansers, including liquid hand soaps. That changed in 2017, when the Food and Drug Administration issued a final rule “determining that certain active ingredients in over-the-counter topical antiseptics [including triclosan] used in health care settings are not considered generally recognized as safe and effective due to insufficient data.”

That ruling was due to two main factors, according to New York City–based dermatologist and AAD fellow Dr. Anne Chapas. First, “high-dose triclosan has been associated in some studies with thyroid hormone abnormalities,” Chapas said in an email. And second, when triclosan was used in over-the-counter antiseptic products, the FDA “did not receive any evidence that triclosan provides a benefit to human health.”

CHG’s high potency increases its risk of negative side effects, from dry skin to severe (though rare) and possibly fatal allergic reactions.

Nowadays, triclosan has largely been replaced by another active ingredient, called benzalkonium chloride. Like CHG, benzalkonium chloride is a broad-spectrum antiseptic that can kill bacteria, fungi, and viruses. Both can also damage your skin’s microbiome (that is, the healthy balance of good and not-so-good bacteria keeping rashes, inflammation, and other skin issues at bay). But CHG is risky in other ways as well.

“CHG binds to the epidermis,” Del Campo explained. “It’s literally stuck on your skin for a while, continuing to exert its antimicrobial effects for up to 6 hours after application.”

Although this makes it a great option for surgical procedures that can take several hours, its high potency also increases the risk of negative side effects, from dry skin to severe (though rare) and possibly fatal allergic reactions.

Prolonged use of either chemical can reduce the amount of good bacteria on your skin and contribute to antibiotic resistance, Chapas said in a phone interview. “If you’re using a strong antibacterial soap for no particular reason,” she added, “it could cause acne, rosacea, folliculitis, and other skin conditions.” In many cases, these are the very same skin problems that influencers claim CHG cleansers can solve.

For those who are curious about using Hibiclens or Hibiscrub as a skin-care product, the good news is that there are several widely available, over-the-counter products that disinfect and reduce unwanted bacteria while being much gentler on the skin and causing few to no side effects. If you’re well versed in acne-fighting ingredients, you’ve probably already heard of them.

Del Campo said that products containing benzoyl peroxide, salicylic acid, and hypochlorous acid (HOCl) are all better options for treating dermatitis, folliculitis, body odor, and more. “One, they are more affordable. Two, they are less likely to deregulate the microbiome. And three, they have different active ingredients that we know work better on these common skin conditions that have been extensively studied.”

As an added benefit, benzoyl peroxide in particular “works to kill bacteria, but it doesn’t cause drug resistance,” Chapas said. Its main drawback is that it can be irritating; if benzoyl peroxide has dried out your skin in the past, she suggested looking for formulas with lower concentrations (2.5% instead of the more-common 5% or 10%).

Although products containing CHG are available over the counter, the experts we spoke with said you should use them only under a dermatologist’s supervision, to treat specific concerns, such as hidradenitis suppurativa, severe cysts, or severe folliculitis.

“I don’t think this is something that you should put in your regular skin-care routine,” Chapas said. “I would really only use it if a dermatologist thinks it’s beneficial for you as a short-term treatment.”

Good old-fashioned soap is still the undisputed champion of effective germ killing. Perhaps the only downside is that most people don’t use it the right way.

“When used in the correct way, soap is awesome and has less effect on the normal microbiome,” Del Campo said. “But some people only put it on for two seconds and then wash it off, which is not going to cut it.”

The CDC recommends lathering with regular, non-antibacterial soap for at least 20 seconds before rinsing with clean, running water and drying thoroughly, either with a clean towel or by air-drying. Unfortunately, the USDA reported in 2018 that 97% of consumers don’t wash their hands correctly. And a 2013 study from Michigan State University found that most people wash their hands for an average of only six seconds.

Even when you’re not in a place with ideal hand-washing conditions—say, while you’re camping or out in public—whatever you can do to get closest to the CDC’s recommendations is still a good option. In particular, Chapas said that “the act of vigorous rubbing, especially, will help remove bacteria off our skin.”

In a statement, the FDA told us that “consumer antiseptic washes have not yet been shown to be more effective at preventing illness than plain soap and water.” But it does support using an alcohol-based hand sanitizer (again, not a cleanser containing benzalkonium chloride, or CHG) when soap and water are not available. In those cases, the FDA recommends looking for a sanitizer that contains at least 60% ethanol.

This article was edited by Katie Okamoto and Maxine Builder.

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Rose Maura Lorre

Rose Maura Lorre is a senior staff writer. Her byline has appeared in The New York Times, Esquire, Salon, Business Insider, HGTV Magazine, and many more. She lives in New Jersey with her husband, her daughter, one dog, two cats, and lots and lots of houseplants.