International Journal of Cosmetic Science, 2007, 29, 131138

Effect of fluid intake on skin physiology: distinct

differences between drinking mineral water and tap
water
S. Williams, N. Krueger, M. Davids, D. Kraus and M. Kerscher
Division of Cosmetic Sciences (FB 13), University of Hamburg, Martin-Luther-King Platz 6, D-20146 Hamburg,
Germany

Received 3 July 2006, Accepted 20 December 2006

Keywords: bioengineering, drinking, fluid, skin, water

1

Part of this study was presented as a poster on the 64th Annual Meeting of the American Academy of
Dermatology, 37 March 2006 in San Francisco, CA, USA.

Synopsis
It is generally stated that drinking plenty of water
has a positive influence on skin condition. However, there is no published scientific study that has
investigated this matter. The aim of our exploratory before-after study was to evaluate the in vivo
influence of drinking more than 2 L of mineral
water or ordinary tap water per day on skin physiology. Ninety-three healthy subjects were included
in our prospective study. After an initial run-in
phase of 2 weeks to monitor individual drinking
habits, subjects had to drink 2.25 L day)1 of either
mineral water (n 53) or tap water (n 40) for
4 weeks. Bioengineering in vivo measurements on
the volar forearm included sonographic evaluation
of skin thickness and density, determination of
skin surface pH, assessment of skin surface morphology, and measurement of finger circumference. Eighty-six subjects completed the study. In
the mineral water group measurements revealed a
statistically significant decrease in skin density.
Skin thickness increased slightly, albeit not at a
statistically significant level. However, when separately analysing those individuals from the mineral
Correspondence: Professor Martina Kerscher, MD,
Division of Cosmetic Sciences (FB 13), University of
Hamburg, Martin-Luther-King Platz 6, D-20146
Hamburg, Germany. Tel.: +49 40 42838 7235;
Fax: +49 40 42838 2592;
e-mail: martina.kerscher@uni-hamburg.de

water group, who had routinely drunken comparably little before the start of the study, their skin
thickness increased at a statistically significant
level. Skin surface pH remained almost unchanged
in the physiologically optimal range. In the tap
water group, skin density increased significantly,
while skin thickness decreased significantly. Skin
surface pH decreased at a statistically significant
level. While in the mineral water group finger circumference decreased significantly, measurements
in the tap water group revealed a statistically significant increase. Objective skin surface morphology did not change in any group. In summary,
drinking more than 2 L of water per day can have
a significant impact on skin physiology. The exact
effects within the skin seem to differ depending on
the nature of the water ingested. Randomized,
controlled, double-blind follow-up trials are warranted to confirm the findings of our exploratory
pilot study.

Resume
Il est generalement etabli que boire abondamment
de leau influence letat de la peau. Cependant,
aucune etude scientifique publiee ne traite de ce
sujet. Le but de notre etude exploratoire avant/
apre`s a ete devaluer in vivo linfluence de
labsorption de plus de 2 litres par jour deau
minerale ou du robinet sur la physiologie de le
peau. 93 sujets en bonne sante ont participe a`

2007 Society of Cosmetic Scientists and the Societe Francaise de Cosmetologie

131

S. Williams et al.

Effect of fluid intake on skin physiology

cette etude prospective. Apre`s une phase initiale

de 2 semaines pour controler les habitudes individuelles des sujets pour se desalterer, on leur a
demande de boire 2,25 litres par jour deau
minerale (n 53) ou deau du robinet (n 40)
pendant 4 semaines. Les mesures biophysiques
in vivo sur la face interne de lavant bras incluaient levaluation sono graphique de lepaisseur de
la peau et de sa densite, la determination de son
pH de surface, levaluation de sa morphologie de
surface et la mesure de la circonference du
doigt. 86 sujets ont termine cette etude. Dans
le groupe traite par leau minerale, les mesures
reve`lent des diminutions significatives de la densite
de la peau. Son epaisseur augmente lege`rement
mais a` un niveau non-significatif. Cependant,
quand on analyse separement les individus de ce
groupe, on constate que ceux qui habituellement
buvaient peu deau avant le debut de cette etude
ont lepaisseur de leur peau qui augmente de facon
significative. Le pH de surface de la peau reste a`
peu pre`s inchange dans la fourchette physiologique optimale. Dans le groupe traite a` leau du
robinet, la densite de la peau augmente de facon
significative, alors que son epaisseur diminue
significativement. Le pH de surface de la peau
diminue de facon significative. Alors que la circonference du doigt du groupe qui a bu de leau
minerale diminue de facon significative, celle du
groupe traite a` leau du robinet augmente de facon
significative. La morphologie de la surface de la
peau ne change pas, quel que soit le groupe. En
resume, labsorption de plus de 2 litres deau par
jour peut avoir un impact significatif sur la physiologie de la peau. Les effets au niveau de la peau
semble dependant de la nature de leau ingeree. Des tests aleatoires controles en double aveugle seront necessaires pour augmenter les resultats
de cette etude exploratoire.
Mots cles: biophysique, boisson, fluide, peau, eau

Introduction
Depending on age, gender and body mass index,
approximately 4570% of our body weight consists of water with one-third of the total body
water being extracellular and two-thirds within
the intracellular compartment [1]. The movement
of water across cell membranes, which are freely
permeable to water, maintains the osmotic equilib-

132

rium between the two compartments. Our overall

body fluid balance is dependent on the input of
water on the one hand (e.g. from drinking, food
and metabolism) and the loss of water on the
other hand (e.g. through urine, faeces, skin and
lungs). The daily intake of appropriate amounts of
fluid is of uttermost importance for optimal function of the human body, as water is one of the
most vital macronutrients for the maintenance of
life [2,3]. Water plays an important physiological
role in temperature regulation, cardiovascular
function, transportation of oxygen and nutrients
to cells, removing waste, tissue structure maintenance and many others [3]. It has been proposed
that fluid consumption in general and water
intake in particular can have an effect not only on
the risk of nephrolithiasis, but also on hypertension, hyperglycaemia in diabetic ketoacidosis and
constipation [413]. Regarding the potential effect
of water on cancer, the findings of epidemiological
studies investigating the relationship between fluid
intake and bladder or colon cancer are inconsistent [14]. Two new reports confirm this general
statement [1517].
The recommended daily water intake is usually
stated as 1 mL kcal)1 of energy expended for
adults [18,19]. However, this recommendation is
often increased to 1.5 mL kcal)1 to cover variations in conditions of energy expenditure and environmental exposure. The Food and Nutrition
Board of IOM bases water needs on adequate
intake which is based on experimentally derived
intake levels that are expected to meet nutritional
adequacy for essentially all members of a healthy
population. The DRIs for water are 3 L day)1 for
an adult man and 2.2 L day)1 for an adult
woman [20], although there are other voices challenging the frequently encountered advice of
drinking about 2 L of fluid per day [21]. American
Food Consumption Surveys indicated that a significant portion of the population may be chronically
mildly dehydrated and it has been stated that
humans, unlike other mammals, have a delay in
rehydration after fluid loss [2,22]. If a fluid deficit
is not replaced adequately, the human body will
eventually extract water not only from the blood,
but also from tissues including skin and mucous
membranes [23]. To restore the bodys fluid
losses, water is especially suited, as added ingredients such as carbohydrates, proteins and/or fat
themselves affect the bodys water balance. Consumption of alcohol and caffeine-containing bever-

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S. Williams et al.

Effect of fluid intake on skin physiology

ages is not ideal as they promote an increased rate

of diuresis [24,25].
All three components of the skin epidermis,
dermis, and subcutaneous fat tissue participate
in water regulation, but the main water reservoir
within the skin is the dermis. However, it is the
stratum corneum water content which plays a
crucial role in maintaining many of the skins biophysical properties [2629]. A healthy stratum corneum consists of about 2030% water and a
water content of less than 1020% results in clinical xerosis with reduced elasticity and increased
skin surface roughness [30]. Already more than
50 years ago, Irvin H. Blanks pioneer work published in the Journal of Investigative Dermatology
highlighted the critical role of the cutaneous water
content and its effect on the plasticity of the skin
[31]. Blank concluded that its (the skins) physical characteristics are a function more of its water
content than its lipid content.
Despite increasing medical and public interest in
water intake, very little scientific data are available
on the effect of water consumption and systemic
hydration state on skin physiology. Although it is
generally said that drinking about 2 L water per
day is supposed to have a positive influence on
skin condition and skin quality, there is no convincing study available supporting this statement.
The aim of our study was to evaluate the in vivo
influence of drinking 2.25 L mineral water or
ordinary tap water per day on skin physiology.
Subjects and methods
The study took place from January 2005 to July
2005 in the skin physiology laboratory of the Division of Cosmetic Sciences, University of Hamburg.
A convenience sample of healthy volunteer men
and women aged 1860 years with no systemic
illness or skin diseases was recruited. Exclusion criteria included chronic and acute systemic diseases
(e.g. diabetes, viral infections, etc.), chronic and
acute skin diseases (e.g. eczema, psoriasis, urticaria, etc.), pregnancy, breast feeding, and administration of a systemic medication or application of
topical preparations within the test area. Ninetythree subjects (67 women, 26 men) were included.
All volunteers continued living in their usual environment. After an initial non-intervention run-in
phase of 2 weeks to monitor individual drinking
habits, subjects had to drink 2.25 L day)1 of either
mineral water (n 53; 38 female, 15 male) or

Table I Mean values (mg L)1) of consumed mineral and

tap water
Mineral water (Staatlich Fachingen medium)
Sodium (in particular as NaHCO3)
Calcium
Magnesium
Hydrogen carbonate
CO2
Tap water (Water works, Nordheide, Germany)*
Sodium
Calcium
Magnesium
Hydrogen carbonate
Potassium
Ion
Chloride
Sulphate
Nitrate
Fluoride

560
92.5
56.6
1812
4500
8
42
2
130
1
0.03
10
12
0.6
0.09

*Mean values, may vary slightly from year to year.

tap water (n 40; 29 female, 11 male) for

4 weeks. The water was at room temperature. The
mineral water used was Staatlich Fachingen medium (Fachingen, Germany), a mineral-rich water
of pH 5.8 (measured inside the bottle) and a total
mineral content of 2711 mg L)1 (see Table I for
details). The tap water used for this study (pH 7.0)
was supplied by Water works (Nordheide, Germany; see Table I for details). Subjects in the
mineral water group were provided with 84 bottles of Staatlich Fachingen medium (each bottle
containing 0.75 L), of which they had to drink
three bottles per day. Subjects in the tap water
group measured the required amount of tap water
themselves after thorough instruction by one of
the investigators. As the taste of Staatlich Fachingen mineral water and tap water is very different
and thus a double-blind design would not have
been possible, we decided to conduct this pilot
study on an exploratory basis. Subjects were asked
to drink the water evenly distributed over the
whole day, to avoid excessive sun exposure and
intense physical activity and not to change their
dietary and daily life habits during the study period. To monitor their diet and fluid intake and
screen for potentially confounding influences, all
subjects led a food and drink diary over the entire
run-in phase and study period.
Bioengineering measurements were performed
on the volar forearm at the beginning (baseline)
and after 4 weeks drinking phase at randomized

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Effect of fluid intake on skin physiology

times during the day. All subjects were measured

in an air-conditioned room under standardized
conditions after an acclimatization period of at
least 20 min. Noninvasive in vivo measurements
included evaluation of (i) skin thickness and skin
density, (ii) skin surface morphology, (iii) skin surface pH and (iv) finger circumference.
Skin thickness (thickness of dermis and epidermis) and skin density in the dermal compartment
were quantified with high-frequency ultrasonography. The 20 MHz ultrasound scanner DUB 20
(Taberna pro medicum, Luneburg, Germany) was
used to obtain cross-sectional images of the skin
(B-mode), which were analysed digitally. Objective
evaluation of skin surface morphology was performed using the Visioscan VC 98 (Courage &
Khazaka, Cologne, Germany). This instrument
allows a direct optical analysis of skin surface
topography through means of a high resolution
UVA-light video camera together with special software. The following Visioscan parameters for skin
roughness und wrinkleness were evaluated: SEr,
SEsm, volume and C_R2. Skin surface pH was
measured using the pH Meter PH 900 (Courage
& Khazaka), which consists of a flat glass probe
combining measurement and reference electrode
in a single probe. The pH metre was calibrated
using standard buffers. Each time three pH measurements were taken on the skin surface with the
mean of these three measurements being used for
subsequent calculations and statistical analysis.
Exact finger circumference was measured manually at the base of the right ring finger.
Statistical analysis was performed on an
exploratory basis using SPSS. All values are
expressed as mean standard error (SEM). Intraindividual statistical comparison of values before

and after the 4-week drinking period was performed descriptively through means of two-tailed
statistical tests (nonparametric Wilcoxon test
for paired samples). P 0.05 was considered
statistically significant (marked with * asterisk in
diagrams), P 0.001 was considered statistically highly significant (marked with *** in diagrams).
Results
Eighty-six subjects completed the study; 50 subjects in the mineral water group (36 female, 14
male; mean SD: 31.8 8.9 years) and 36 subjects in the tap water group (26 female, 10 male;
mean SD: 31.8 8.7 years). Seven of the recruited 93 volunteers did not complete the study for
personal reasons or protocol violations. An overview of our results with exact P-values can be
viewed in Table II.
Skin density
In the tap water group, skin density increased
highly significantly from 47 2.4 at baseline to
54 1.9 after the 4-week drinking phase (Fig. 1).
In contrast, measurements in the mineral water
group revealed a significant decrease from
45 2.15 before to 39 2.49 at the end of our
study (Fig. 1).
Skin thickness
Skin thickness decreased in the tap water group at
a highly significant level (1122 26.66 at baseline vs. 1062 22.8 after the drinking period, see
Fig. 2). In the mineral water group overall, skin

Parameter

Mineral water group

Skin density
Skin thickness

(P 0.003)
(P
(entire group: P 0.187)
(P
(subgroup of subjects, who had
previously drunken little: P 0.031)
(P > 0.05)
(P <
(P 0.005)
(P
(P > 0.05)
(P >

Skin surface pH
Finger circumference
Skin surface morphology
(SEr, SEsm, R2, and volume)

Tap water group

0.001)
0.001)

Table II Summary of results with

P-values (paired Wilcoxon test,
before vs. after the 4-week drinking
phase)

0.001)
0.038)
0.05)

: statistically significant increase; : slight increase; : statistically significant decrease;

: no change.

134

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S. Williams et al.

Skin density (arbitrary units)

Effect of fluid intake on skin physiology

60

Skin surface morphology

***
Day 0
Day 28

55
**

50
45

54

40
45
35

47
39

30
Mineral water

Tap water

Change of skin thickness (%)

Figure 1 Sonographic skin density before (baseline) and

after 28 days of drinking 2.25 L of mineral water
(n 50) or tap water (n 36) per day (**P 0.01,
***P 0.001).

6%

Mineral water
Tap water

4%
2%

Skin surface pH
While the skin surface pH remained unchanged in
the physiologically optimal range in the mineral
water group (P > 0.05; see Fig. 4 for details), pH
significantly decreased in the tap water group
(5.19 0.10 before vs. 4.79 0.08 after the
drinking phase; Fig. 4).

0.8 %

Finger circumference

0%
2%
4%

The mean values of all evaluated Visioscan skin

surface morphology parameters (SEr, SEsm, R2
and volume) did not reveal any statistically significant alteration after drinking 2.25 L of mineral or
tap water daily for 28 days. However, in individual subjects in both groups, a considerable
smoothening of the skin surface texture was
observed (Fig. 3).

5.3 % ***

6%

Figure 2 Change in sonographic skin thickness after

28 days of drinking 2.25 L of mineral water (n 50) or
tap water (n 36) per day (***P 0.001, compared to
baseline).

thickness did not change at a statistically significant level (slight increase from 969 22.19 at
baseline to 977 24.19 after the drinking period,
Fig. 2). However, when separately analysing those
individuals from the mineral water group, who
had routinely drunken comparably little before
the start of the study (<2 L day)1), their skin
thickness
increased
statistically
significant
(P 0.031).

In the mineral water group the finger circumference measured on the base of the ring finger
decreased significantly from 6.34 0.09 to
6.16 0.10 cm, while measurements in the tap
water group revealed a significant increase from
6.74 0.10 to 6.81 0.08 cm (Fig. 5).
Discussion
Adequate fluid intake, in particular from non-alcoholic, non-caffeinated and non-caloric beverages
such as water has been shown to be beneficial
for various aspects of general health and to be
protective against diverse medical conditions
[27,913]. Despite the acknowledged physiological significance of water to life and the general
claim that the consumption of ample amounts of
water is somehow beneficial for skin, very little is
known about the objective in vivo influence of

Figure 3 Visioscan example (female

subject, 30 years of age) of skin surface morphology on the volar forearm before (a) and after (b) 4 weeks
of drinking mineral water.

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S. Williams et al.

Effect of fluid intake on skin physiology

Skin surface pH

6.0

Day 0
Day 28
***

5.5
5.0
5.49

5.38

5.19

4.5

4.79

4.0
Mineral water

Tap water

Finger circumference (cm)

Figure 4 Skin surface pH before (baseline) and after

28 days of drinking 2.25 L of mineral water (n 50) or
tap water (n 36) per day (***P 0.001).

Day 0
Day 28

7.5

7.0
**
6.5
6.0
5.5
5.0

6.74
6.34

6.81

6.16

4.5
Mineral water

Tap water

Figure 5 Ring finger circumference before (baseline) and

after 28 days of drinking 2.25 L of mineral water
(n 50) or tap water (n 36) per day (*P 0.05,
**P 0.01).

water intake on different aspects of skin physiology. With our study, we were able to demonstrate
that the consumption of more than 2 L of water
per day can indeed have a measurable influence
on skin physiology in healthy volunteers. Furthermore, the concrete effects seem to depend on the
exact nature of the ingested water. In detail, our
measurements revealed that mineral water causes
a significantly reduced finger circumference, a statistically significant decrease in sonographic skin
density and in those individuals, who had previously drunken comparably little a significantly
increased skin thickness. The observed changes
were higher in probands, who had previously
drunken comparably little. Pure tap water on the
other hand led to a significantly increased finger
circumference, significantly increased skin density
and significantly decreased skin thickness.
Not all of the objectively measured changes can
be explained straightforwardly, as the exact underlying mechanisms necessitate further research in
this area. However, the decrease in skin density

136

with increase in skin thickness in the mineral

water group might be due to an increased dermal
fluid content, for example though means of a stimulation of cutaneous metabolism with improvement of dermal water binding capacity. It is well
known that skin thickness does not only depend
on the amount of cells and extracellular fibres
such as collagen, but also on the interstitial fluid
content. High-frequency ultrasound studies have
confirmed that an increasing fluid content leads to
increased skin thickness with inverse changes in
cutaneous echodensity [32,33]. The fact that the
finger circumference did not rise, but actually
decreased at a statistically significant level, suggests that our probands did not develop any clinical oedema by tissue fluid retention. The
decreased finger circumference could also be a sign
of a general loss of body weight, which was not
measured in our study. Mineral water originates
from rain water, which over decades and centuries
trickled through various layers of rock in the
ground and thus acquired a mixture of minerals
from these stone layers. The mineral water we
used for our experiment was obtained from a
depth of 400 m. It has been shown that minerals
from mineral water are highly bioavailable and
well absorbed [3436]. In contrast to mineral
water, ordinary tap water contains a much lower
content of minerals such as hydrogen carbonate
and magnesium (Table I). It has previously been
shown that consumption of mineral-rich water
can exert distinctively different effects on the skin
compared to water with low mineral content. In
patients with atopic eczema for example deep sea
water intake was able to improve clinical skin
symptoms and decrease serum IgE, IL-4, IL-13 and
IL-18, while distilled water intake had no effect
[37].
Objective assessment of skin surface profile did
not reveal statistically significant changes in any
group. This is interesting, as it is generally claimed
that drinking lots of water might reduce visible
signs of cutaneous ageing such as wrinkles and
lines. We could not confirm any objective improvement of wrinkles or skin surface roughness after
increasing the daily water uptake to more than
2 L over 4 weeks. Whether there might be measurable changes after a longer drinking phase
remains to be investigated in future research. In
this context, it would also be interesting to objectify the in vivo elasticity of the skin through means
of bioengineering measurements, e.g. cutometry.

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S. Williams et al.

Effect of fluid intake on skin physiology

The skin surface pH is another important

parameter of skin physiology and influences various other factors such as composition of stratum
corneum lipids, hydration, epidermal barrier function and growths of physiological and pathological
micro-organisms. Even small alterations in stratum
corneum pH may cause significant modifications
at the molecular level. While after drinking mineral water, the skin surface pH remained in the
physiologically optimal range of approximately
5.5, the pH actually decreased at a statistically significant level in the tap water group, although the
ingested tap water itself had a neutral pH of 7,
while the mineral water was with 5.8 within the
acidic range. The exact reason of the lower skin
surface pH after drinking ample amounts of tap
water remains unclear. However, these data are in
accordance with a study from Boelsma et al., who
described an inverse relationship between fluid
intake and skin surface pH in men [38]. It remains
to be elucidated why there was no decrease
observed when drinking mineral water, especially
after Boelsma et al. also described a significant
association between increased dietary calcium
intake and decreased skin surface pH in men [38].
However, there might have been confounding
influences of other minerals such as magnesium
with impact on, for example, regulation of proliferation, differentiation and desquamation of keratinocytes [39], which potentially could have
prevented the pH from decreasing.
In conclusion, drinking more than 2 L of water
per day can have a significant impact on skin
physiology, the exact pathogenetic factors of
which remain to be revealed in future research.
Interestingly the effects within the skin seem to
differ depending on the nature of the water ingested. Randomized, controlled, double-blind followup trials are warranted to confirm the findings of
our exploratory pilot study. However, this is an
important new area of research into applied skin
physiology which will in future hopefully bring
out many more insights into the influences of
macro- and micronutrient intake on skin physiology, especially as in recent years, commercial
offers of functional foods claiming skin benefits
have increased enormously.
Acknowledgements
We are indebted to all participating subjects for
their cooperation and compliance throughout this

study. We would also like to thank Heike Buntrock, Volker Braun, Sandra Schroder, Alexandra
Butehorn, Annette Schuler and Tatjana Schwill
for their dedication and diligence, which made the
successful execution and completion of this study
possible.
Part of this study was sponsored by Staatlich
Fachingen, Fachingen, Germany.
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