Innate Immune System of Skin and Oral Mucosa

Properties and Impact in Pharmaceutics, Cosmetics, and Personal Care Products

Nava Dayan, Philip W. Wertz

• Publisher: Wiley
• Year: 2011
• ISBN:
  9781118025321
• Edition: 1
• Topic: Medicine
• Subtopic: Dermatology

An in-depth look at cutting-edge research on the body's innate immune system

Innate immunity is the body's first line of protection against potential microbial, viral, and environmental attacks, and the skin and oral mucosa are two of the most powerful barriers that which we rely on to stay well. The definitive book on the subject, Innate Immune System of Skin and Oral Mucosa: Properties and Impact in Pharmaceutics, Cosmetics, and Personal Care Products provides a comprehensive overview of these systems, including coverage of antimicrobial peptides and lipids and microbial challenges and stressors that can influence innate immunity.

Designed to help experts and newcomers alike in fields like dermatology, oral pathology, cosmetics, personal care, and pharmaceuticals, the book is filled with suggestions to assist research and development. Looking at the many challenges facing the innate immune system, including the impact of topically applied skin products and medications, Innate Immune System of Skin and Oral Mucosa paves the way for next generation treatment avenues, preventative approaches, and drug development.

Part I

Overview of Skin and Mucosal Innate Immunity: History, Ethics, and Science

Chapter 1

Germ Free: Hygiene History and Consuming Antimicrobial and Antiseptic Products

Jennifer Tebbe-Grossman and Martha N. Gardner

Massachusetts College of Pharmacy and Health Sciences Boston, MA

1.1 Introduction

In our current society, cleanliness is a virtue. Our conventional wisdom is that washing our hands and body with personal care products is something we all should do to maintain our health—and social acceptability. However, what the “virtue” of cleanliness is—as well as the products that we use in order to become clean—has changed significantly over time. In fact, cleanliness has not always been viewed as a virtue. Europeans and Americans began to significantly identify cleanliness as a cornerstone of health and morality only in the mid-nineteenth century. From this period through the early to mid-twentieth century, public health efforts to implement infection control, cleanliness, and hygiene practices in hospitals, schools, workplaces, and the home developed. Relatedly, in the late nineteenth century, the medical and scientific community, as well as the general public, debated but eventually accepted antisepsis and the germ theory of disease. Marketed products emerged with promises to keep you clean, destroy germs, assure economic advancement and social desirability, assuage guilt, and uphold morality.

Beliefs about hygiene and cleanliness have varied over time and place. In Western Europe, from the classical Roman era through the nineteenth century, the use of public or private home baths, for instance, was alternately considered desirable for medicinal or social purposes or unacceptable because of concerns about immorality or health dangers [1, 2]. Throughout this time period, the foundational theory of health and disease in Western civilization posited a balance of “humors” in the body that needed to be kept in equilibrium [3]. Many Europeans feared and generally avoided water, especially hot water, since they believed its moisture opened pores to bad air, poisons, and disequilibrium within the body [1]. With the appearance of the “Black Death” in Europe, many argued that using water made people easy targets for the plague's invasion through their moistened pores [4].

From the 1500s to the 1700s, the important factor in cleanliness “applied exclusively to the visible parts of the body” ([1], p. 226). Faces and hands were splashed with water in basins but more intimate parts of the body were not washed. As people began to understand the role of skin, its oils, and perspiration, white linen was perceived for some time as a way of cleansing the body. Those who could afford to changed and washed their linen ([4], p. 106). Perfumes also masked body odor while a variety of “objects of refinement”—gloves or handkerchiefs—“defended the user against external dirt” ([5], p.192). Not until the late seventeenth and early eighteenth centuries did the growing bourgeois classes come to think of cleanliness as hygiene in connection to a healthy body. It became acceptable to bathe (without soap) the whole body in warm water for its “purifying function.” Personal hygiene soon became a moral and civilizing issue ([1], pp. 170, 193). By the mid-nineteenth century, historians Richard and Claudia Bushman argued that “cultural values” had “interlocked with social forces that gave cleanliness intense social importance.” For the middle classes,

Dirty hands, greasy clothes, offensive odors, grime on the skin—all entered into complex judgments about the social position of the dirty person and actually about his or her moral worth . . . Cleanliness indicated control, spiritual refinement, breeding; the unclean were vulgar, coarse, animalistic. (Source: Ref. [6], p.1228.)

Since the poor had little access to water, cleanliness became a class as well as a moral issue.

Cleanliness in the public environment posed additional problems. As people moved from rural to urban areas, population density greatly increased, and with it, poor sanitation. Urban streets and alleys were strewn with excrement, dead animals, and garbage. Water was scarce, filthy, and foul smelling. Working sewer systems were virtually nonexistent. Endemic and epidemic diseases flourished [7, 8]. Within the context of beliefs that “miasmas” or filth and foul smelling air caused disease, nineteenth-century public health reformers focused on improving urban sanitation through such policies as garbage collection and disposal, well-engineered sewer systems, and indoor plumbing systems. The public effort to improve sanitation was a massive one. Water became an increasingly important element of everyday life in public and private places, and sewer systems and pipes for running water were built in short order during the late nineteenth and early twentieth centuries [9–12].

As sanitation improved and cleanliness became an accepted social value, soaps also improved. Early soaps, generally very harsh and used for household cleaning, were often made at home in small batches by boiling some combination of animal fat and alkali (e.g., plant or wood ashes). The so-called “toilet” soap for personal use did not appear to be more generally utilized until a natural vegetable oil was added in the early 1600s and the first soap companies began to form. Such alkaline and olive oil-based soap products as the Castile soap from Spain were favored by wealthier social classes that could afford to purchase the products. Men used toilet soaps for shaving while women saw them as luxurious and costly cosmetics. With the rise of a consumer-based economy in Europe and the United States in the late nineteenth century, people relied less on their “homemade soap or chunks of soap bought at the local dry goods store” and began to purchase “packaged” soap bars ([13], p. 54). Producing in ever greater volume, early soap companies marketed their products to schools and hospitals and sold them in general stores, drugstores, and later grocery stores.

As the soap industry would continue to grow, concerns about both soap's purity and skin irritation and its civilizing characteristics would recur in advertisements and public commentary. In 1885, the Reverend Henry Ward Beecher endorsed Pears soap declaring that “if Cleanliness is next to Godliness Soap must be considered as a Means of Grace and a Clergyman who recommends moral things should be willing to recommend Soap” ([6], p. 1218). During the nineteenth century, various technological and transportation changes allowed for soaps to be produced more cheaply and in greater volume, especially as companies sought “purity” in soap and experimented with various oils—olive, cottonseed, coconut, and palm [4, 14].

This chapter will look at hospital and home settings as places where health professionals and consumers pursued cleanliness as they came to connect cleanliness to health. Three historical moments emphasize how fears about dirt, infection, and the spread of disease related to efforts to develop and use cleanliness products. The first moment occurred in the nineteenth and early twentieth centuries primarily as a medical conflict emerged over the connection between cleanliness and disease. The second moment occurred with the discovery of such “miracle drugs” as sulfonamides and antibiotics (especially penicillin) in the 1940s. The third moment took place in the 1990s as fears about “new” or “emerging” bacteria and infections prompted new waves of hygiene products in the late twentieth and early twenty-first centuries.

1.2 Hygiene Beliefs and Products as the Germ Theory Emerges (Nineteenth to Early Twentieth Centuries)

1.2.1 Early Ideas and Realities Concerning Hand Washing in the Hospital

The struggle for physicians to understand the causes of maternal and infant mortality during childbirth was the first moment when physicians made the connection between cleanliness and disease. “Childbed fever” (also called “puerperal fever”) was a serious problem from the seventeenth to mid-twentieth centuries, sometimes reaching epidemic proportions—especially among women who had physicians deliver their babies. Although most physicians rejected the idea that their practices could cause this disease, it is clear now that they in fact were the culprits. Hand washing and other cleanliness practices were not yet used, and physicians typically went from one bedside to another without changing their clothing or washing their hands. In some instances, puerperal fever could kill up to two-thirds of women during childbirth [15].

By the late eighteenth century, some physicians began to speculate on their involvement in this disease. Their speculation preceded scientific understanding of germ theory. Alexander Gordon, who practiced medicine in Aberdeen, Scotland, published in 1795, A Treatise on the Epidemic Puerperal Fever of Aberdeen. In it, he argued that women were “seized” by “a specific contagion” that was “delivered” by a physician or nurse “who had previously attended patients affected with the disease . . .” He acknowledged “I myself was the means of carrying the infection to a great number of women.” ([16], p. 35). This prophetic idea did not immediately catch on, however. In 1843, prominent American physician Oliver Wendell Holmes published a paper, “The contagiousness of puerperal fever,” in which he argued that “the disease known as Puerperal Fever is so far contagious as to be frequently carried from patient to patient by physicians and nurses” (author's italics) ([17], p. 131). He saw that the spread of the disease occurred “through the agency of the examining fingers.” He suggested a variety of methods to prevent the spread of this disease including urging physicians and nurses to wash their hands in chlorinated water when treating obstetric patients. Although some physicians listened to Holmes' ideas, most challenged Holmes' conclusions about personal contagion and did not improve their hygiene as they treated patients [17].

Unaware of Holmes' research, Hungarian obstetrician Ignaz Semmelweis observed in 1847 that attending physicians and medical students at a teaching hospital in Vienna performed gynecological exams without washing their hands. Based on observation, Semmelweis mandated that physicians and surgeons scrub their hands with a brush and chlorinated lime solution before touching patients. The rate of death fell “from 20% to 1%” and was slightly lower than that of the midwife ward for the brief time that physicians followed the hand-washing regimen ([18], p. 1284). Historians have argued that he “sabotaged” his discovery by arrogantly ordering colleagues to change their habits rather than more effectively advocating for hand cleansing. His important assertion that the main cause for the deaths among the young women in the obstetrics ward was contaminated hands was not accepted [17, 19, 20].

Rather than an outright rejection of hand washing, many physicians who doub...

Table of contents

• Cover
• Title Page
• Copyright
• Preface
• Contributors
• Part I : Overview of Skin and Mucosal Innate Immunity: History, Ethics, and Science
• Part II : Antimicrobial Lipids and Peptides
• Part III : Host Cellular Components of Innate Immunity
• Part IV : Innate Immunity Response to Stress and Aging
• Part V : Innate Immunity Microbial Challenges
• References
• Index