Review

Skin Pharmacol Physiol 2006;19:296–302 Received: September 2, 2005

Accepted after revision: December 22, 2005
DOI: 10.1159/000094670 Published online: July 19, 2006

The pH of the Skin Surface and

Its Impact on the Barrier Function
M.-H. Schmid-Wendtner a H.C. Korting b
Departments of Dermatology and Allergology, a Rheinische Friedrich Wilhelm University, Bonn, and
b
Ludwig Maximilians University, Munich, Germany

Key Words tis, ichthyosis, acne vulgaris and Candida albicans infec-
Acid mantle
Barrier function
Skin cleansing
tions. Therefore, the use of skin cleansing agents, espe-
Skin pH
Synthetic detergents cially synthetic detergents with a pH of about 5.5, may
be of relevance in the prevention and treatment of those
skin diseases.
Abstract Copyright © 2006 S. Karger AG, Basel

The ‘acid mantle’ of the stratum corneum seems to be

important for both permeability barrier formation and
cutaneous antimicrobial defense. However, the origin of Introduction
the acidic pH, measurable on the skin surface, remains
conjectural. Passive and active influencing factors have The acidic nature of the skin surface was first deter-
been proposed, e.g. eccrine and sebaceous secretions as mined by Heuss in 1892 [1]. Since then numerous studies
well as proton pumps. In recent years, numerous inves- have confirmed this observation. In 1928, Schade and
tigations have been published focusing on the changes Marchionini published their experiments on the skin pH
in the pH of the deeper layers of the stratum corneum, using more exact biophysical methods. They introduced
as well as on the influence of physiological and patho- the ‘gas chain bell electrode’ adapted for the skin [2]. The
logical factors. The pH of the skin follows a sharp gradi- acidic skin pH was interpreted as being due to impregna-
ent across the stratum corneum, which is suspected to tion of the horny layer with acidic constituents or eccrine
be important in controlling enzymatic activities and skin sweat, because in intertriginous areas and in regions sup-
renewal. The skin pH is affected by a great number of plied by apocrine glands the reaction was less acidic or
endogenous factors, e.g. skin moisture, sweat, sebum, even neutral. Potentiometric measurements carried out
anatomic site, genetic predisposition and age. In addi- by Blank [3] revealed skin pH values between 4.2 and 5.6.
tion, exogenous factors like detergents, application of Since the beginning of the 1950s, the flat glass electrode
cosmetic products, occlusive dressings as well as topical was used more and more for skin pH measurements [4].
antibiotics may influence the skin pH. Changes in the pH Schirren showed the equivalence between the plate glass
are reported to play a role in the pathogenesis of skin electrode and the quinhydrone electrode measurement
diseases like irritant contact dermatitis, atopic dermati- facing reproducible pH values around 5.2 for both meth-

© 2006 S. Karger AG, Basel Monika-Hildegard Schmid-Wendtner, MD

1660–5527/06/0196–0296$23.50/0 Department of Dermatology and Allergology, Rheinische Friedrich Wilhelm University
Fax +41 61 306 12 34 Sigmund-Freud-Strasse 25, DE–53105 Bonn (Germany)
E-Mail [email protected] Accessible online at: Tel. +49 228 287 5370, Fax +49 228 287 4333
www.karger.com www.karger.com/spp E-Mail [email protected]
Table 1. Factors influencing skin pH ac- Barrier Function
cording to Rippke et al. [16], Yosipovitch
and Maibach [18] and Jacobi et al. [25]
The formation of the stratum corneum barrier in-
Endogenous factors volves several pH-dependent enzymes, especially with
Age respect to its lipophilic components and its destruction
Anatomic site by desquamation. These hydrolases include
-glucoce-
Genetic predisposition rebrosidase, acid sphingomyelinase, acid lipases, phos-
Ethnic differences phatases and phospholipases [9].
-Glucocerebrosidase
Sebum
Skin moisture
with an optimum pH of 5.6 is involved in the synthesis
Sweat of the most important ceramides.
Exogenous factors At the stratum granulosum/stratum compactum inter-
Detergents, cosmetic products, soaps face there is a release of acid hydrolases (contents of the
Occlusive dressings lamellar bodies) into the extracellular space by differenti-
Skin irritants
Topical antibacterials
ated keratinocytes. Together with those hydrolases, glu-
cosylceramides and phospholipids play an important role
in the lamellar arrangement of barrier lipids [10]. In vitro
experiments showed that the formation of lamellar struc-
tures in mixtures of horny lipids requires an acidic milieu
ods [4]. On the basis of different experimental methods, [11]. This observation was confirmed by in vivo studies
Tronnier [5] suggested pH values closer to the alkaline in hairless mice which showed a significantly faster recov-
range (pH 6.4–6.5), while Zlotogorski [6] even more re- ery of the barrier function after acetone insult or adhesive
cently reported pH values between 4.0 and 4.9. The over- film-stripping when exposed to more acidic buffer solu-
all evaluation of publications which are generally recog- tions [10]. Leyvraz et al. investigated the epidermal bar-
nized today suggests a surface pH value of the human skin rier function in dependence on proteolytic enzymes [12].
(forearm of a healthy adult white male) of 5.4–5.9 [7]. They regenerated mice lacking the membrane-anchored
However, there are ‘physiological gaps in the acid barrier’ channel-activating serine protease (CAP 1) in skin, and
which deserve special attention. This refers in particular these mice died within 60 h after birth. Besides a lower
to the axillae, the genitoanal region and the interdigital body weight they exhibited severe malformation of the
area. Due to the alkaline environment, the normal bacte- stratum corneum, which was accompanied by an im-
rial flora in these areas is considered different. paired skin barrier function. As evidenced by dehydra-
Newer results concerning factors influencing the acid tion and skin permeability assay and transepidermal wa-
mantle of the skin as well as the role of skin pH in differ- ter loss measurements, this resulted in a rapid and fatal
ent skin diseases are the subject of this review. dehydration [12].
Various investigations revealed that low pH values in
the extracellular space play an important role in the regu-
Definition and pH Measurement lation of enzyme activity, especially in keratinization and
barrier regeneration [13–15]. In this respect, acidic buffer
The pH is defined as the negative logarithm (base ten) substances applied topically may contribute to the main-
of the concentration of free hydrogen ions in aqueous so- tenance of the normal barrier function of the skin.
lution. The neutral point is 7 and the maximum values
of the acidic and alkaline ranges are 0 and 14, respec-
tively. The pH of the extractable water-soluble compo- Factors Affecting Skin pH
nents of the skin can be measured. The skin pH and the
buffering capacity of the skin surface are made up of the The pH of the skin surface can be influenced by a num-
contributions from all the components of the stratum cor- ber of endogenous (physiological) and exogenous factors
neum as well as the secretions from sebaceous and sweat [16–18]. The most important of these (table 1) are dis-
glands. Today, potentiometric methods, especially with cussed in more detail.
flat glass electrodes, are preferred for skin pH measure- Age has long been known to influence the skin pH.
ments, since they are more accurate compared with col- Previous studies indicated that the skin undergoes a pro-
orimetric methods [8]. cess of adaptation and maturation postnatally. In recent

pH of the Skin Surface Skin Pharmacol Physiol 2006;19:296–302 297

years, experimental studies especially focused on infants, ture: areas with higher moisture such as the axilla and
small children and the elderly. Visscher et al. [19] report- inguinal regions have a higher pH.
ed relatively neutral surface pH values in neonates with In historic reports, differences in sweat pH according
a decrease to about 5.5 over the first 4 postnatal days. to the sweating intensity are reported [26]. Until today
These data were confirmed by Yosipovitch et al. [20] who there is no confirmation that thermal sweat, sweat from
measured elevated initial mean pH values of 7.08 (SD covered body areas and sweat from eccrine glands really
0.17) with significant decreases of pH by day 2. Hoeger is more acidic than sweat from effort, air-exposed skin
and Enzmann [21] assessed skin function parameters areas and apocrine glands.
(skin surface pH, corneal layer hydration, epidermal des- There are numerous external factors affecting the
quamation, and surface roughness) prospectively in a co- measured skin surface pH. One of the most important
hort of 202 healthy term neonates. They found a decrease ones is skin cleansing. A pH rise for few hours at least is
in surface pH by 0.3–1.1 units, while desquamation in- observed after cleansing the skin with alkaline soaps (pH
creased significantly during the observation period (12 10.5–11.0). The use of synthetic detergents formulated
weeks). In addition, stratum corneum hydration increased at the same pH as skin and even tap water also leads to
significantly, paralleled by a decrease in skin roughness a rise of the skin surface pH, however to a lesser extent
[21]. Data concerning the skin pH of schoolchildren are and for a shorter period of time [27, 28]. It is assumed
inhomogeneous. There might be a reduced resistance to that such temporary skin pH changes are limited to the
alkaline noxae despite an unremarkable basal pH. In con- uppermost layers of the stratum corneum, which was ex-
trast, both an increased skin surface pH and a reduced amined using the tape-stripping method [17]. About 15
buffer capacity have been documented for skin of the el- years ago, Korting et al. [29, 30] were one of the first
derly [22]. In the 18–60-year age group, the skin surface groups who examined the effect of different skin cleans-
pH remains constant in most anatomical sites [22]. ing methods in healthy volunteers focusing on the bacte-
Comparing data obtained from different anatomical rial flora and the skin surface pH. In a clinical crossover
sites may often be inappropriate because skin surface study one half of the healthy volunteers washed their
composition is not necessarily uniform and hygiene hab- foreheads and forearms twice daily for 1 min with soap,
its may be totally different depending on the body area. the other volunteers washed with a syndet with an acid-
However, it is generally accepted that skin surface pH is ic pH. After 4 weeks, the respective other skin cleansing
relatively similar at different body sites except in areas agent was used for the next 4 weeks. At the beginning of
with higher moisture: the intertriginous areas (the axilla, the study and at the end of every week, skin pH and den-
inguinal and submammary folds and finger webs) have a sity of the bacterial flora were determined [29]. When
slightly higher pH than other body areas [7, 23]. soap was used first, the pH increased. After change-over
Skin pH has occasionally been reported to vary with to the syndet the pH dropped. When the syndet was ap-
ethnic and genetic background. However, racial differ- plied first, the pH dropped slightly, but after changing to
ences in skin have been minimally investigated by objec- soap it increased to values above the initial values [29].
tive methods. It has been demonstrated that people with Statistical evaluations showed that the pH values were
black skin have a lower skin surface pH than people with about 0.3 units lower in the case of long-term application
white skin [24]. The assumption that brown-skinned in- of the acidic syndet. However, after individual washing,
dividuals from India might have a slightly different skin both the soap and the syndet led to a short-term increase
surface pH compared with Europeans has not yet been in pH, which regressed within a few hours [26]. After re-
proven by exact statistical methods [17]. Studies concern- peated soap washing, the count of propionibacteria in-
ing gender-related differences in skin physiology provid- creased strongly and dropped after repeated syndet ap-
ed conflicting results. A newer investigation involving 6 plication. Moreover, for the forehead a correlation could
female and 6 male volunteers revealed a higher pH for be established between germ species and the skin surface
women (5.6 8 0.4) than for men (4.3 8 0.4, p ! 0.05) pH [29]. Various topical products, for example deodor-
[25]. ants, have been reported to affect the skin surface pH, at
The sebum of the skin has a moderate effect on the pH least for a few hours [31, 32]. The effects of occlusive
to be measured. The effect depends on the amount of se- dressings on the skin surface pH have been known for
bum. For example, a high sebum content on the forehead several decades. Hartmann [33] demonstrated a signifi-
in a patient with acne vulgaris may artificially affect the cant increase in the skin surface pH in healthy volunteers
pH measurement. Skin pH also depends on skin mois- after 3 days of occlusion with a return to the baseline pH

298 Skin Pharmacol Physiol 2006;19:296–302 Schmid-Wendtner /Korting

value only 1 day after removal of the occlusive dressing. in patients in a symptom-free interval [41]. These find-
Elsner and Maibach [34] reported a significant decrease ings were corroborated by Sparavigna et al. [42], who
in the skin pH after drying of primary occluded skin of compared the cutaneous pH of 143 children with atopic
the vulva, associated with a significant reduction of the dermatitis and 141 healthy children, aged 3 months to
transepidermal water loss. This was explained by an in- 11 years. They reported a progressive decrease in pH
creased ion permeability of the stratum corneum because values from lesional to perilesional to unaffected skin
of occlusion, resulting in neutralization of the acidic skin sites, and to corresponding skin sites of healthy children
surface [34]. In addition, a delay in restoration of the [42]. Eberlein-König et al. [40] examined 377 primary
barrier function after occlusive acetone treatment was schoolchildren for skin surface pH, stratum corneum hy-
described associated with a rise in the skin surface pH dration, transepidermal water loss and skin roughness.
[35]. Only the skin pH differed significantly, with higher mean
values in the 45 children with atopic dermatitis com-
pared with the healthy children. Furthermore, an elevat-
Skin pH in Diseases ed pH could be correlated with the severity of dryness
and itching [40].
Both lipid organization and lipid metabolism in the Whereas the significance of free fatty acids for the al-
stratum corneum require an acidic pH. Alterations in terations of pH in atopic skin remains inconclusive [43],
those processes contribute to the disturbance of skin bar- recent findings suggest that urocanic acid may play a key
rier function observed in different skin diseases. Today role in maintenance of the acidic pH of the stratum cor-
we know that a disturbed stratum corneum skin pH has neum [44]. According to the authors, urocanic acid is pro-
important clinical implications in several clinical situa- duced from histidine by a self-regulated control cycle,
tions, for example in psoriasis and atopic dermatitis [36] involving the pH-dependent activity of the enzyme histi-
as well as in more rare dermatoses like the Netherton syn- dase for the maintenance of moisture content and pH of
drome [37]. Frequent skin diseases with disturbed skin the stratum corneum. Other studies confirmed a signifi-
pH are discussed in more detail below. cant reduction in urocanic acid and suggested a dimin-
ished histidase activity in atopic skin [45].
Atopic Dermatitis
Several pathogenetic and therapeutically relevant fac- Irritant Contact Dermatitis
tors in atopic dermatitis can be affected by changes in The pH of the skin surface can also be used to predict
skin surface pH. Besides genetic and immunologic fac- the risk of individuals without atopic background to de-
tors, skin dryness caused by a disturbance of skin barrier velop irritant contact dermatitis. Wilhelm and Maibach
function and microbial colonization may play an impor- [46] compared several skin parameters in 10 healthy vol-
tant role. About 50 years ago there was initial evidence unteers before and after inducing skin irritation with 1%
for an altered skin surface pH in patients with atopic der- sodium lauryl sulphate. The authors reported significant
matitis. Epprecht [38], for example, described elevated correlations for the surface pH, the pH of the deeper
pH values of the skin surface, with slower alkaline neu- stratum corneum layers exposed after five tape strip-
tralization, in patients with acute disseminated atopic pings, but not for the transepidermal water loss, sebum
dermatitis. Schnyder et al. [39] determined a reduced al- content or renewal rate of the horny layer [46]. These
kaline resistance in 83% of patients with atopic dermati- findings were confirmed by the group of Francomano
tis compared with 17% of those with healthy skin. These [47] who observed higher pH values of the cheeks in pa-
early data have been confirmed in recent years by numer- tients with sensitive skin objectively prone to skin irri-
ous systematic studies, using planar glass electrodes for tations, than in healthy volunteers. Disturbances of the
pH measurement [40, 41]. skin pH play a pathogenetic role in infants, too. Ammo-
Seidenari and Giusti [41] showed that the pH values nia-induced alkalinization activates stool enzymes such
measured in eczematous and in clinically uninvolved as lipase and trypsin, leading to irritation and disruption
skin areas were significantly higher in patients with atop- of the skin barrier, where the skin has been reported in
ic dermatitis than those in healthy children. In addition, some cases to already have an elevated baseline pH of
the pH values in eczematous skin areas were significant- 6.6 [48].
ly higher than in unaffected areas, which in turn were
significantly higher in patients with clinical findings than

pH of the Skin Surface Skin Pharmacol Physiol 2006;19:296–302 299

 Ichthyosis
Öhman and Valquist [49] compared the pH gradients
of the horny layer of patients with X-chromosomal reces-
sive ichthyosis and autosomal dominant ichthyosis vul-
garis with those of healthy volunteers. The pH on the skin
surface in patients with ichthyosis vulgaris was signifi-
cantly higher (5.3, SD 0.7) than in patients with X-chro-
mosomal recessive ichthyosis (4.6, SD 0.4), and was high-
er than the pH of healthy skin (4.5, SD 0.2). A neutral pH
was reached in patients with ichthyosis vulgaris after half
the horny layer had been removed using the tape stripping
method. In contrast, in patients with X-chromosomal re-
cessive ichthyosis, a plateau pH value of 6.2–6.6 was nev-
er exceeded even in the lower stratum corneum. It was
concluded that in patients with ichthyosis vulgaris there
is a congenital deficiency of acid degradation products of Fig. 1. Number of facial inflammatory acne lesions in a compara-
filaggrin, whereas in patients with X-chromosomal reces- tive trial with 3-month application of either soap or acidic syndet
sive ichthyosis there is an accumulation of cholesterol (from Korting et al. [57], with permission).
sulphate in the lower horny layer induced by a lack of
steroid sulphatase, leading to a flattening of the pH gradi-
ent [49]. As a result, pH-dependent enzymes involved in Skin pH and Skin Cleansing
desquamation of the skin may be disturbed. Reduced fil-
aggrin formation levels have been confirmed in patients Even rinsing the skin with water alone immediately
with ichthyosis vulgaris, lamellar ichthyosis and congen- produces a transient increase in the skin pH [54]. Wash-
ital ichthyosiform erythrodermia [50]. The steep amino ing the hands with conventional soap causes the pH on
acid gradient, with high values in the deep horny layer of the palms to increase by an average of 3 units. Even 90
healthy skin, is much flatter in ichthyosis vulgaris. This min after washing with soap the pH of the hands was not
might explain the advantage of special acidic topical completely normalized [55]. However, soaps were used
preparations containing lactic acid for keratolysis in pa- for over thousands of years for regular skin cleansing,
tients with ichthyosis vulgaris. while synthetic cleansers of the liquid or the bar type
have started to become an alternative just about 30 years
Fungal Infections in Special Patient Populations ago. Keining [56] was the first to describe the advantages
Yosipovitch et al. [51] compared skin surface pH and of the so-called syndets. He mentioned a decreased irri-
moisture in intertriginous areas in 50 non-insulin-depen- tancy potential, lack of sensitization and capability to
dent diabetic patients and healthy volunteers. They mea- maintain or even restore the acid mantle of the skin [56].
sured significantly higher pH values in the intertriginous Today, the value of acidic syndets in the therapy of var-
skin areas of these patients (but not on the forearms) com- ious skin diseases is widely accepted on clinical grounds.
pared with the healthy control group. This was interpret- For quite a while, a close relationship has been postu-
ed as a risk factor for the development of candida myco- lated between skin surface pH and its microbial flora
ses [51]. In another investigation, a significant increase in (transient and resident). Bacteria can grow over a wide
the skin pH in patients on dialysis was reported [52]. The pH range, but no microorganisms will grow equally at all
changes observed, relating to the tendency to develop my- pH values. Most grow better at a pH around neutrality.
cotic skin infections, were considered to have clinical rel- Acidic pH could be bacteriostatic for some strains. Kort-
evance [52]. In an experimental setting, Candida albicans ing et al. [57], for example, investigated the influence of
cell suspension, buffered either at pH 6.0 or 4.5, was ap- the regular use of a soap or an acidic syndet bar on acne-
plied to healthy skin under occlusion. After 24 h, there prone patients. In a randomized, open-labeled, compar-
were significantly less mycotic skin lesions at the acidic ative trial the 3-month application of either skin cleans-
site, which confirms the relevance of an intact acidic mi- ing preparation to facial skin for 1 min each in the morn-
lieu for the patient’s defense capability against fungal in- ing and in the evening was compared in 120 adolescents
fections [53]. and young adults with inflammatory acne I or II accord-

300 Skin Pharmacol Physiol 2006;19:296–302 Schmid-Wendtner /Korting

ing to the Plewig and Kligman classification [57]. The Conclusion
number of inflammatory acne lesions, i.e. papulopus-
tules, differed in the two trial groups from 4 weeks of A central role for the acidic milieu as a regulating fac-
application onward. In the group using soap the mean tor in stratum corneum homeostasis was postulated. This
number of inflammatory lesions increased from 14.6 has relevance for the integrity of the barrier function,
(SD 5.3) to 15.3 (SD 6.0), while it decreased in the other from normal maturation of the stratum corneum lipids
group from 13.4 (SD 5.2) to 10.4 (SD 5.8; p ! 0.0001; fig. through to desquamation. An elevated skin pH may also
1). Acidic syndet bars, in addition, showed a better toler- influence the activity of the enzymatic process of lipid
ability. The authors concluded that acidic cleansers metabolism in the stratum corneum, which might con-
should be preferred for skin care in acne-prone adoles- tribute to a dramatic skin barrier anomaly observed, for
cents and young adults. example, in atopic dermatitis. In addition, changes in
Just recently, the impact of acidic hand cleansers for skin pH become clinically significant because of the cre-
prevention of rhinovirus infections has been investigat- ation of a favorable environment for the growth of bacte-
ed, since direct hand-to-hand contact is an important ria, especially Staphylococcus aureus. Because of their
mechanism of transmission of rhinovirus infection [58]. bacteria-regulating properties and favorable tolerability
Hands of volunteers were contaminated with rhinovirus profile, syndets with an acidic pH are now preferred for
at defined times (15 min, 1 h and 3 h) after use of acidic skin cleansing in patients with seborrheic-type diseases
hand cleansers (containing salicylic acid and/or pyroglu- (acne vulgaris, rosacea), atopic skin diathesis, irritant
tamic acid). Then volunteers attempted to inoculate the contact dermatitis and ichthyosis. Moreover, special pop-
nasal mucosa with one hand while quantitative viral cul- ulations such as diabetic patients or patients on dialysis
tures were done on the other hand. Virus was recovered may profit from washing with acidic syndets because the
from the hands in 90% of the volunteers in the con- occurrence of fungal infections may be reduced. There is
trol group compared with 15% in the groups who used good reason to believe that acidic syndets are of value
acidic hand cleansers after 15 min. Rhinovirus infection even for persons with healthy skin, for example to prevent
occurred in 32% of patients in the control group and in rhinovirus transmission and infection.
only 7% of patients in the treatment groups. The authors
suggested the feasibility of the prevention of rhinovirus
transmission by acidic hand treatments that are viru-
cidal on contact and have activity that persists after ap-
plication [58].

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