The correct choice of cosmetic products and cleansers is very important to improve skin hydration, to provide moisturizing benefits and to minimize cutaneous damage caused by surfactants. In fact, surfactants may damage protein structures and solubilize lipids. Soaps, defined as the alkali salts of fatty acids, are the oldest surfactants and are quite aggressive. Syndets (synthetic detergents) vary in composition and surfactant types (anionic, cationic, amphotheric, non-ionic). These new skin cleansing products also contain preservatives, fragrances, and sometimes emollients, humectants and skin nutrients. We present a revision of the literature and discuss recent findings regarding skin cleansers.

Contact allergy is a possible adverse effect of natural products. Baseline series supplemented with the commonest botanical allergens may be adequate for detecting most of the cases of contact allergy to natural topical products.

Background: Plasma cell vulvitis is a clinically and histologically well-characterized chronic disease that usually relapses after various topical therapies. Considering the inflammatory nature of the disease, the new topical calcineurin inhibitors have been also employed successfully in few cases of Zoon’s balanitis, the corresponding male condition. Objective: The aim of our study is to evaluate the effectiveness of tacrolimus ointment in a small group of plasma cell vulvitis sufferers. Methods: 4 women affected by biopsy-proved plasma cell vulvitis were enrolled, after informed consent. The topical drug was applied twice daily for 6 weeks, then tapered on the basis of the clinical results. Symptoms and objective parameters were obtained periodically at the beginning, after 6 weeks and up to the end of the topical treatment. A final biopsy was performed in 3 out of our 4 patients. The follow-up is still ongoing. Results: The comparative analysis of subjective, objective and histopathological data has shown discordant and less encouraging results than those reported for the corresponding male condition. Conclusion: At the moment, topical tacrolimus could be considered an alternative treatment for plasma cell vulvitis only in cases resistant to conventional therapies.

Lichen sclerosus is a chronic relapsing disease, usually treated with ultra-potent corticosteroids. As immunological alterations are considered important aetiopathogenetic factors in lichen sclerosus, the new immunomodulating topical agents, such as tacrolimus and pimecrolimus, have been employed sporadically as alternative therapies. The aim of this study was to evaluate the therapeutic effects of tacrolimus 0.1% ointment in lichen sclerosus in 11 patients unresponsive or poorly responsive to previous treatments. Tacrolimus 0.1% ointment was applied twice daily for 6 weeks, then tapered over a further 6 weeks. Symptoms and objective parameters were evaluated and quantified at the start, after 6 weeks, at the end of the topical treatment, and at follow-up visits. Improvement or remission of symptoms was observed in the patients who completed the study, while objective parameters were poorly influenced and often were not related to symptom behaviour. Topical tacrolimus can be considered an alternative treatment for lichen sclerosus.

Background: Although topical remedies and cosmetics based on herbal ingredients are becoming increasingly popular with the public due to the perception that botanical compounds are safer and healthier than their synthetic counterparts, a large number of adverse cutaneous effects of plant extracts, notably contact sensitization, have been reported in medical literature. Objective: To evaluate the prevalence of herbal compound usage in a dermatological out-patient population and to estimate the incidence of consequent cutaneous side effects. Methods: 400 patients were subjected to a self-administered 15-item questionnaire to assess both prevalence and type of topical botanical preparations used and occurrence of skin adverse reactions. Results: 241 patients (60.25%) reported use of natural topical products, predominantly aloe, marigold, chamomile, propolis and arnica. Females used herbal products, for both medicinal and cosmetic purposes, more frequently than males. 15 patients (6.22%) referred one or more adverse cutaneous reactions. Conclusion: Herbal preparations were widely used in the examined population, but, despite the common belief in the innocuous nature of botanical extracts, the incidence of side effects referred by the patients confirms that they should be regarded as a potential source of adverse skin events. The lack of adequate patch testing in case of suspected contact allergic dermatitis, incomplete or misleading product labelling, and the risk of chemical adulteration may represent further concerns as regards application of botanical products