Chlorine Dioxide Complex Cleanser: A New Agent With Rapid Efficacy for Keratosis Pilaris
May 2018 | Volume 17 | Issue 5 | Original Article | 554 | Copyright © May 2018
Matthew J. Zirwas MDa and Jill Fichtel MDb
aOhio Contact Dermatitis Center, Dermatologists of Greater Columbus, Columbus, OH bDermatologists of Greater Columbus, Columbus, OH
Chlorine dioxide complex™ is a new molecule to dermatology that is a unique, non-toxic, broad spectrum anti-microbial and keratolytic compound. Chlorine dioxide has been used as an antiseptic in industrial settings for decades, primarily in water treatment facilities for municipal water supplies and food preparation. The compound has exceptional antiseptic properties with no known potential for development of resistance. It is a true keratolytic and anti-inflammatory, but is non-toxic to human tissue due to its unique mechanism of action. Chlorine dioxide’s use in consumer products was previously limited because it is inherently an unstable molecule that had to be used quickly after it was produced. However, the recent development of a complexed form of chlorine dioxide that retains its antimicrobial and keratolytic activity has allowed the development of products (AsepticMD, Aseptic Plus, Nashville, TN) that take advantage of the properties of this unique molecule. Here we report a case series demonstrating its efficacy as a cleanser in keratosis pilaris. J Drugs Dermatol. 2018;17(5):554-556.
Chlorine dioxide (ClO2) is a volatile, reactive gas at room temperature that was first synthesized in 1811. Early uses included as a pulp bleaching agent for paper making and as a disinfectant, but it was too expensive for routine industrial use until the 1940s. It has since been used in 5-10% of municipal water treatment facilities for water disinfection and deodorizing and is widely used as a food disinfectant.1,2 Although ClO2 gas is toxic at high concentrations by inhalation, when it is solubilized in water and applied to human tissue there is an absence of toxicity due to deactivation by intracellular defenses and the unique mechanism of action.3When tested for antibacterial effectiveness against other antiseptics, such as bleach, hydrogen peroxide, iodophors, chlorhexidine, quaternary ammonium compounds, and others, ClO2 is the most effective agent, both against typical organisms and against multidrug resistant Staph and Pseudomonas.4-6 It also has excellent activity against viruses, yeast and mycobacteria, as well as bacterial spores and biofilms.6-17 In addition, it is anti-inflammatory by neutralizing reactive oxygen molecules and cytokines and also acts as a true keratolytic, degrading both the inter- and intramolecular disulfide bonds that stabilize keratin.18-20While ClO2 complex™ has numerous potential applications in dermatology, early experience has demonstrated exceptional efficacy in keratosis pilaris, primarily related to its keratolytic effects.
Report of Cases
Table 1 outlines the demographics, clinical findings, and response to therapy of patients treated with chlorine dioxide complex wash (AsepticMD, Nashville, TN) in the authors’ practice. All patients used the foaming facial cleanser and were instructed to wash once daily, gently rubbing the affected area for 5-10 seconds with a soft cotton cloth. No additional moisturizers, abrasion, or other interventions were used.
Keratosis Pilaris (KP) is a common complaint, affecting between 10% and 30% of the population. Onset is typically in childhood and although it frequently improves with age it does commonly persist into adulthood. Typical therapies include moisturizers containing keratolytics such as salicylic acid, lactic acid (or ammonium lactate) or urea. These treatments typically take several weeks to have an effect and must be used on an ongoing basis.21,22 Additionally, more aggressive therapy with topical retinoids has been attempted, but can be limited by irritation and cost.23 Finally, several lasers have been reported to be effective, but treatment is again limited by cost.24-29Chlorine dioxide complex wash led to rapid, nearly complete resolution of keratosis pilaris in the reported patients. It presents several benefits over existing treatments, including low cost and ease of use – essentially all individuals use soap on a daily basis, while daily application of moisturizer is much less likely, especially in adolescents who have notoriously low compliance.Unlike other keratolytics, ClO2 is a highly specific oxidizer – it reacts with several specific amino acids in proteins, but does not react with or oxidize lipids, carbohydrates, or other organic