Triclosan is an antimicrobial agent that is added to consumer products to reduce or prevent the growth of fungi, mildew and bacteria. Triclosan was originally introduced as a pesticide in 1969, and is incorporated into commercial, institutional and industrial premises and equipment. Triclosan is added to conveyor belts and ice-making equipment as an antimicrobial pesticide. Triclosan is also used as a preservative for materials that include fabrics, adhesives, clothing, carpeting and footwear. Triclosan has been a popular ingredient in many over the counter products, specifically antiseptic wash products such as hand soaps, bar soaps and body washes.
The Food and Drug Administration (FDA) is responsible for regulating personal care products containing triclosan under the Federal Food, Drug, and Cosmetic Act (FFDCA). However on December 19, 2017 the FDA issued another final rule stating that 24 ingredients including triclosan found in OTC antiseptic products are not recognized as safe and effective for use. So starting December 20, 2018 companies are not able to use triclosan and the other 23 ingredients in their products without premarket review. The FDA and Environmental Protection Agency (EPA) have been working together on addressing scientific and regulatory issues regarding triclosan. The EPA plays a major role in regulating triclosan as a pesticide, together both the EPA and FDA are hoping to accurately measure the extent of negative impact triclosan has on human health.
Some animal studies have shown that high exposure to triclosan will reduce thyroid hormone levels. There are current animal studies undergoing that are evaluating the safety and effectiveness of triclosan, regarding potential of developing skin cancer after long term exposure to triclosan. A study on human participants is currently being conducted regarding the breakdown of triclosan with other chemicals on human skin after UV sunlight exposure. According to the FDA, there hasn’t been clear evidence to prove that OTC antibacterial soaps are more effective than just plain soap and water in preventing illnesses. In order to distinguish OTC antibacterial products, these products will usually have the word “antibacterial” written on the label, along with the drug facts label listing antibacterial ingredients.
The Centers for Disease Control and Protection (CDC) has listed several guidelines on proper hand hygiene. On a daily basis our hands are susceptible to germs, bacteria and of course the SARS-CoV-2 virus. All those germs and bacteria are spread when we touch our faces, especially the eyes, nose and mouth with unwashed hands. Bacteria and the virus will spread when we touch contaminated surfaces/objects and consume food/beverages with unwashed hands. During the pandemic it has been a crucial step to maintain a proper hand washing etiquette. Refer to the CDC website for more information but some crucial times to wash the hands include; before consuming food/beverage, after using the bathroom, after coughing/sneezing/blowing nose, and when caring for someone who is sick or infected with the SARS-CoV-2 virus. The CDC has five steps on how to wash hands: 1.) Wet hands with clean water and apply soap 2.) Lather hands by rubbing them together with the soap, be sure to get the back of the hands, in between fingers and underneath fingernails. 3.) Scrub hands for a minimum of 20 seconds (sing happy birthday twice) 4.) Rinse the lather with clean water 5.) Dry hands with towels or air-dry.
When soap and water is not an option, the CDC recommends hand sanitizer that contains at least 60% alcohol as indicated by the product label. In order to correctly use hand sanitizer, apply a quarter sized amount and rub all over the hands until dry for around 20 seconds.
5 Things to Know about Triclosan. U.S. Food & Drug Administration. https://www.fda.gov/consumers/consumer-updates/5-things-know-about-triclosan. Reviewed 2019 May 16. Accessed 2021 June 9.
Q&A for Consumers: Health Care Antiseptics. U.S. Food & Drug Administration. https://www.fda.gov/drugs/information-drug-class/qa-consumers-health-care-antiseptics. Reviewed 2017 December 19. Accessed 2021 June 9.
Antibacterial Soap? You Can Skip It, Use Plain Soap and Water. U.S. Food & Drug Administration.https://www.fda.gov/consumers/consumer-updates/antibacterial-soap-you-can-skip-it-use-plain-soap-and-water. Reviewed 2019 May 16. Accessed 2021 June 9.
Triclosan. United States Environmental Protection Agency. https://www.epa.gov/ingredients-used-pesticide-products/triclosan. Accessed 2021 June 9.
When and How to Wash Your Hands. Centers for Disease Control and Protection. https://www.cdc.gov/handwashing/when-how-handwashing.html. Reviewed 2020 November 24. Accessed 2021 June 9.
Hand soaps are a common cosmetic product used multiple times a day by the general population. There are many different kinds but the two main distinctions are antibacterial hand soap versus regular soap. Triclosan is an ingredient added to hand soap to give it antibacterial capabilities. It can also be found in cosmetic products like body washes, deodorants, toothpastes and others. Because people should wash their hands before and after using the bathroom and preparing food, things we do more than once in a day, Triclosan exposure would be great if it was in the hand soap being used. Washing hands is important to keep food clean, prevent bacterial spread, and reduce spread of illness from person to person.
The FDA has no evidence proving Triclosan has increased efficacy compared to hand soaps without it. It does have evidence from various animal studies that exposure to high doses of Triclosan is associated with a decrease in the levels of some thyroid hormones. We do not know the relevance of this in terms of human health. There is also a theory that Triclosan is responsible for making some bacteria resistant to antibiotics, but that is inconclusive as well. Overall, the risks of utilizing daily products that contain Triclosan outweigh any potential benefit. As of 2017, Triclosan was banned from liquid hand soaps but remains in common over the counter products like toothpaste and body wash. There are multiple ongoing studies to truly determine if Triclosan is toxic or harmful to humans. They are looking to test the potential development of skin cancer after long term exposure to Triclosan. Another study is to look at Triclosan breakdown after exposure to light and UV rays. Overall, data is still inconclusive across the board.
The FDA’s ruling to remove Triclosan from all hand soaps remains in effect and they advise the general population to look at ingredient lists before purchasing any products. Their rule states “certain active ingredients used in over-the-counter (OTC) consumer antiseptic products intended for use with water are not generally recognized as safe and effective and are misbranded,” referring to Triclosan among others. We as pharmacists can show patients where to spot the ingredient list on their body washes, toothpastes or deodorants, and we can let them know products without Triclosan are just as effective.
1. 5 Things to Know About Triclosan. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/5-things-know-about-triclosan#:~:text=Triclosan is an ingredient added, and Drug Administration (FDA). Published May 15, 2019. Accessed January 30, 2021.
The importance of handwashing has been highlighted within the past year due to the coronavirus pandemic. While it was always recommended to wash your hands often, the emphasis of increased handwashing has been echoing in the ears of every person as we overcome this pandemic.
Handwashing is important because of the buildup of bacteria and germs on a person’s hands. This can be from touching an object that someone else has touched before, handling food, using the restroom. Handwashing can prevent the spread of germs by killing the bacteria and germs on the hands before the germs get into a person’s eye, mouth, or nose. Reducing the amount of illness from these germs and bacteria can lead to a decrease in antibiotic use and decrease the amount of antibiotic resistance happening here in the US.
To properly wash your hands, wet your hands first with warm water. After turning the water off, apply regular soap and rub hands, including the back of your hands and in between your fingers, together for 20 seconds. Rinse lathered soap off your hands with warm water and either air dry your hands or use a paper towel or hand towel.
Triclosan is an antibacterial ingredient found in products used to wash your hands and teeth- hand soap, body soap, and toothpaste. In 1997, the FDA reviewed the effectiveness and safety data of triclosan in Colgate Total toothpaste. Currently, the FDA has not seen evidence that triclosan in OTC antibacterial soaps and body washes provides an advantage over using regular soap and water. As of December 2017, the FDA issued a final rule and companies will not be able to use triclosan in their products without premarket review because of its insufficient data regarding its safety and effectiveness.
When Triclosan was studied in short-term animal trials, exposure to high doses of triclosan was associated with a decreased level of thyroid hormones. Other studies have shown to prove that exposure to triclosan contributes to an increase in antibiotic resistant bacteria. It is being investigated how triclosan can potentially increase the risk of skin cancer after long-term exposure in animals. Another study is looking into the potential breakdown of triclosan to other chemicals on the human skin after exposure to triclosan to UV rays. Some of these studies do not have results yet, but triclosan is continuing to be studied before it is put back into any OTC products.
It is important to look into your OTC products. If triclosan is in any of your antibacterial soaps and body washes, it would be listed on the Drug Facts label under the ingredients section. Using soaps, body washes, and toothpaste without triclosan is just as effective at killing bacteria and is much safer on the body based on many studies happening concurrently on this potentially harmful ingredient.
5 Things to Know About Triclosan. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/5-things-know-about-triclosan#:~:text=Triclosan is an ingredient added, and Drug Administration (FDA). Published May 15, 2019. Accessed January 30, 2021.
When and How to Wash Your Hands. Centers for Disease Control and Prevention. https://www.cdc.gov/handwashing/when-how-handwashing.html. Published November 24, 2020. Accessed January 30, 2021.
Written by: Denise Cotter and Niyati Doshi
Triclosan is an antimicrobial ingredient usually seen in antibacterial soaps, body washes, toothpastes, hand sanitizers, mouthwash, tooth whitening products, antiperspirants/deodorants, shaving products, creams and some cosmetic products. The purpose of this ingredient is to prevent bacterial contamination, but small amounts can be absorbed through your skin or mouth. Initially in 1972 triclosan was used as a surgical scrub for medical professionals, but slowly this chemical was seen to be added in a variety of products. In 2017, the Food and Drug Administration (FDA) declared that triclosan is not generally recognized as safe and effective (GRASE) for antiseptic products in a healthcare setting. Along with this, in 2016 the FDA banned the use of triclosan in over-the-counter products, which include liquid, foam, and gel hand soaps, bar soaps, and body washes. This ban was made effective because it was not proven whether or not triclosan is safe for long term use. Although the ban of triclosan was implemented in over-the-counter based products, triclosan is still present in hand sanitizer, mouthwash, and toothpaste, specifically Colgate brand, because it has been shown to be helpful in preventing gingivitis. Seeing how this might be useful in prevention of gingivitis, triclosan is well absorbed through the mucous membranes in the mouth, and this can lead to higher levels of the chemical in the body overtime (detected in urine).
Research also showed that triclosan may alter hormone regulation in animals, contribute to development of antibiotic-resistant germs, and might be harmful to the immune system. Triclosan has also been seen to not just cause harm to us but also the environment. All populations can be affected by triclosan, including pregnant and breast-feeding mothers. At least 75% of the U.S. population has triclosan found in their blood, *****, and breast milk. Triclosan itself is an endocrine disruptor and interferes with important hormone functions. This itself can directly affect the brain, the immune system, and reproductive system. Specifics include disturbing thyroid, testosterone, and estrogen regulation. This can lead to many issues including early puberty, poor ***** quality, infertility, obesity, and cancer. Other research and studies show that triclosan can lead to impaired learning and memory, exacerbate allergies, and weaken muscle function. Triclosan can even impact fetal development, infancy, and childhood growth if there is prolonged exposure.
There are no set studies that using a product with an antimicrobial property to wash your hands are more effective than a product without it. Further studies need to be conducted in order to see how triclosan further affects consumers and how its metabolites may cause any further issues. The consumers should still be well aware of the products being purchased and be more aware to read the labels for chemicals and additives that may be potentially harmful to them. Proper handwashing techniques should still be observed, especially washing between the fingers, and if soap and water are not available, choose an alcohol based sanitizer that has 60-95% alcohol to protect from germs. Not all germs will be eliminated but it will still be a more protective method for yourself and others to keep yourself somewhat safe from germs.
Commissioner, Office of the. “5 Things to Know About Triclosan.” U.S. Food and Drug Administration, FDA, www.fda.gov/consumers/consumer-updates/5-things-know-about-triclosan#:~:text=Triclosan%20is%20an%20ingredient%20added,and%20Drug%20Administration%20(FDA).
March 15, 2016 Nicole Greenfield. “The Dirt on Antibacterial Soaps.” NRDC, 15 Dec. 2016, www.nrdc.org/stories/dirt-antibacterial-soaps?gclid=EAIaIQobChMIvPTIrNLP6gIViYbACh3zwAg6EAAYASAAEgLVBfD_BwE.
Tosh, Pritish K. “Should You Worry about Triclosan?” Mayo Clinic, Mayo Foundation for Medical Education and Research, 25 June 2020, www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/triclosan/faq-20057861.
“Triclosan.” Safe Cosmetics, www.safecosmetics.org/get-the-facts/chemicals-of-concern/triclosan/.
Weatherly, Lisa M, and Julie A Gosse. “Triclosan Exposure, Transformation, and Human Health Effects.” Journal of Toxicology and Environmental Health. Part B, Critical Reviews, U.S. National Library of Medicine, 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC6126357/.
Triclosan and Handwashing - Dr. Michelle Lam
Power Point & Script
Triclosan is an antimicrobial agent often used in soaps, body washes, and toothpaste. The Food and Drug Administration (FDA) banned over-the-counter consumer antiseptic wash products that contain triclosan in 2016. The FDA also banned triclosan from antiseptic products used in healthcare settings in 2017 for being ineffective and unsafe. Multiple organizations, including the World Health Organization, Surgical Infection Society, and the American College of Surgeons, stressed that triclosan was an effective antimicrobial agent, but ultimately the FDA ruled that manufacturers provided no evidence that triclosan-containing antibacterial soaps and body washes had any potential benefit over its non-triclosan-containing counterparts (i.e., regular soap and water). Not only did triclosan provide no additional benefit, the FDA found that it may increase bacterial resistance rates through environmental exposure, which is highly alarming in light of rapidly increasing resistance rates internationally.
Triclosan exposure has been found to impair calcium activity in both cardiac and skeletal muscle causing weaker contractions in the heart. It has also been found to disrupt mitochondrial function, decreasing energy in cells and increasing oxygen demand. It also interrupts normal endocrine hormone pathways, namely, the production of testosterone and thyroxine. Several studies link triclosan exposure to developmental and reproductive defects, such as spontaneous abortion, increased time to pregnancy (leading to higher rates of complications), and reduced head circumference. Triclosan also represses the immune system, allowing for increased rates of asthma, allergies, and food sensitization, especially in younger populations when the immune system is still developing. High concentrations of triclosan in the urine are linked to all of the aforementioned conditions.
Triclosan is still in use today in toothpaste and mouthwash for its anti-gingival properties. It is also still found in hand sanitizers although it is unclear whether it offers any benefit. Triclosan is also found in bodies of water and wastewater plants, which may lead to accidental oral ingestion. Its lipophilicity prevents it from breaking down in water, allowing it to gather in wastewater plants, and then be distributed into the environment through the soil or bodies of water.
Commissioner Oof the. 5 Things to Know About Triclosan. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/5-things-know-about-triclosan.
Weatherly LM, Gosse JA. Triclosan exposure, transformation, and human health effects. Journal of Toxicology and Environmental Health, Part B. 2017;20(8):447-469. doi:10.1080/10937404.2017.1399306
Cherednichenko G, Zhang R, Bannister RA, et al. Triclosan impairs excitation-contraction coupling and Ca2+ dynamics in striated muscle. Proceedings of the National Academy of Sciences. 2012;109(35):14158-14163. doi:10.1073/pnas.1211314109
Ajao C, Andersson MA, Teplova VV, et al. Mitochondrial toxicity of triclosan on mammalian cells. Toxicology Reports. 2015;2:624-637. doi:10.1016/j.toxrep.2015.03.012
The benefits of hand washing are being realized and acknowledged by the general population now more than ever before. Hand washing is part of our general hygiene which has become expected most of the time. However, we all have been reminded of the proper technique to hand washing during the COVID-19 pandemic. It’s extremely important to properly wash our hands not only to prevent coronaviruses but also other bacteria and germs that can easily infect us and the people we come in contact with. We should clean our hand before and after eating or preparing food; caring for a patient or treating a wound; and after using the toilet or touching garbage. These are only a few examples of the best times to hand wash, so being vigilant and precocious is always best practice. The proper technique to hand wash consists of wetting hands with water, applying regular soap, then rubbing the hands together and scrubbing for 20 seconds, rinsing them with water, and finally drying the hand. These steps ensure killing the viruses, bacteria, and germs we are concerned about. Therefore, it’s very important to closely follow this technique whenever we’re washing our hands. When soap and water are not available, using a 60-95% alcohol hand sanitizer will eliminate most of germs but not all. Triclosan is another antibacterial and antifungal ingredient that can be found in products like hand soap, body wash and toothpaste. Although effective, triclosan is linked to thyroid hormones imbalances, skin cancer, and antibiotic resistance in animal studies. Assessing its risk in humans is still being researched. For this reason, FDA has banned its use in liquid hand soap since September 2017. However, triclosan can still be found in products like toothpaste, body wash, and deodorant. For this reason, as healthcare providers, always follow the latest research and guidelines and advise patients of the safe and effective ingredients/products to use.
FDA.gov. Is It a Cosmetic, a Drug, or Both? (Or Is It Soap?). August 2018. <https://www.fda.gov/cosmetics/cosmetics-laws-regulations/it-cosmetic-drug-or-both-or-it-soap> [Accessed 4 June 2020].
CDC.gov. When and How to Wash Your Hands. April 2020. <https://www.cdc.gov/handwashing/when-how-handwashing.html> [Accessed 4 June 2020].
Washing hands is the best way to prevent the spread of illness from one person to another. While some soaps are labeled as “antibacterial”, they are not necessarily more effective than just washing one’s hands with regular soap and water. Antibacterial soaps contain certain chemicals, like triclosan and triclocarban, that are intended to reduce or prevent bacterial infection. However, there is limited evidence proving the benefits of these chemicals. In one study, Kim et al examined the in vitro and in vivo bactericidal effects of triclosan in soap and found no significant difference in the bactericidal activity between plain soap and antibacterial soap. While the antibacterial soap did show greater effects after 9 hours, the effects are not significant in the short time of handwashing. In the study, it was concluded that antibacterial soap containing triclosan 0.3% was not more effective than plain soap in reducing bacterial spread under real-life conditions.
Furthermore, questions have been raised over the long-term negative effects of antibacterial active ingredients. Animal studies have shown that triclosan can affect hormone levels in the body, but more research is still needed to assess risk in humans. Studies have also shown a possible link between triclosan and development of antibiotic resistance.
Because manufactures have not been able to produce substantial safety and efficacy data on these products, the FDA has issued a final rule banning the use of most antibacterial active ingredients, including triclosan and triclocarban, from hand soaps, bar soaps, and body washes. The rule does not apply to hand sanitizers or hand wipes, or to the following three chemicals: benzalkonium chloride, benzethonium chloride, and chloroxylenol. Manufactures are still studying safety and efficacy on these ingredients. At present, people should continue washing their hands with plain soap and water to prevent illness and the spread germs. Proper handwashing technique is also important to be effective.
· Antibacterial Soap? You Can Skip It, Use Plain Soap and Water. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/antibacterial-soap-you-can-skip-it-use-plain-soap-and-water. Accessed June 4, 2020.
· Kim SA, Moon H, Lee K, et al. Bactericidal effects of triclosan in soap both in vitro and in vivo. J Antimicrob Chemother. 2015; 70(12): 3345‐52.
Hand washing is something that is so important, but people don’t do it that often. Hand washing is necessary to help get rid of the bacteria and germs that can settle on people’s hands after using the toilet, handling raw meat, or touching objects that have been touched by other people, blowing your nose/coughing/sneezing into the hand, etc. Different viruses and bacterias that can stay on the hands are salmonella, E.coli, and norovirus. Educating people to wash hands can help prevent the spreading of respiratory and diarrheal infections from one person to another. Along with that, it will lead to less infections, therefore less antibiotics will be prescribed and less antibiotic resistance. It is very important to wash hands, especially now during this pandemic its key for patients to have cleanliness to help prevent the spread of this virus and flatten the curve. Some key times people should be washing hands is before, during and after making food, before eating, before and after caring for a sick person, after using the toilet, after handing pet foods, or animal waste, after touching the garbage and many more. There are many different kinds of soaps patients can use to wash hands. An ingredient that was found in soap before was triclosan. Triclosan is an ingredient added to many consumer products, which is known to help with reducing or eliminating bacterial contaminants. This ingredient can be found in soaps, toothpaste, body wash, etc. There have been some animal studies done which showed a decrease in patients thyroid hormone levels, as well as some link to the development of skin cancer and antibiotic resistance. Therefore, it has been banned from being used in soaps since 2017. In cases where you aren’t able to wash hands, you can use hand sanitizer containing 60-95% alcohol which will help eliminate most germs, but not all. Sanitizers don't help get rid of pesticides and heavy metals.
When and How to Wash Your Hands. Centers for Disease Control and Prevention. https://www.cdc.gov/handwashing/when-how-handwashing.html. Published April 2, 2020. Accessed June 4, 2020.
Commissioner Oof the. 5 Things to Know About Triclosan. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/5-things-know-about-triclosan#:~:text=Triclosan is an ingredient added,and Drug Administration (FDA). Accessed June 4, 2020.