pH in Skin Pathophysiology
Surber C, Abels C, Maibach H (eds): pH of the Skin: Issues and Challenges.
Curr Probl Dermatol. Basel, Karger, 2018, vol 54, pp 115–122 (DOI: 10.1159/000489525)
pH and Acne
Nanna Schürer
Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
What Is Already Known?
■ Acne vulgaris seems to correlate with impaired epi-
dermal barrier function within the follicular epithe-
lium.
■ Epidermal barrier function improves through skin
surface acidification. Superficial acidic peels accom-
panied by an acidic (pH <5.0) homecare are thera-
peutic strategies of treating papulo-pustular and
comedonal acne.
What Does This Text Add?
■ While the link “skin surface acidification and epi-
dermal barrier function” is well documented, there
seems to be a lack of studies on skin surface pH and
barrier function in acne. This text offers an intersec-
tion of the following research subjects: (I) barrier
function, (II) skin surface pH, (III) superficial chemi-
cal peels and (IV) acne vulgaris. Controlled clinical
and functional studies are required to support a
possible context.
Abstract
Acne is based on a complex, multifactorial pathophysiol-
ogy beginning with a microcomedo. Comedogenesis in-
volves follicular hyperproliferation and disturbed kerati-
nization, hyperseborrhea and hyperplasia of sebaceous
glands as well as disturbances in skin microbiome. Acne
is treated with antibiotics, retinoids, keratolytics, hor-
monal and anti-inflammatory agents. Efficacy and side
effects of given medications are well known. The upper-
most layer of the stratum corneum is acidic. The low pH
provides protection by slowing down the growth of some
bacteria. Increase of skin surface pH leads to impaired
barrier function, disturbances in skin microbiome and in-
flammation. Acne-predisposed skin is in a constant state
of subclinical inflammation. Subclinical inflammation
may be linked to changes in skin surface pH and distur-
bances of the stratum corneum, allowing microorgan-
isms to stimulate the production of pro-inflammatory cy-
tokines. Here, based on the current literature, the possible
link between the skin surface pH, epidermal barrier func-
tion and acne is reviewed.
© 2018 S. Karger AG, Basel
129.187.254.46 - 8/22/2018 10:32:17 AM
Univ.-Bibliothek der TU München
Downloaded by:
Skin Surface pH
The acidic skin surface pH is the end product of
the pH gradient located within the stratum cor-
neum [1, 2]. Integrity and cohesion of the stratum
corneum [3, 4] as well as the balance of the micro-
bial flora [5] depend on the acidic skin surface
pH.
Numerous endogenous pathways contribute
to the acidic skin surface pH:
(I) Proton-donating free fatty acids (FFA) gen-
erated from the hydrolysis of epidermal phospho-
lipids and other complex lipids in the late stages
of differentiation play an important role in acidi-
fication [6].
(II) Lipase activities of resident bacterial flora
and sebaceous glands produce FFA accumulating
on the skin surface [7].
(III) Energy-requiring pathways like the Na+/
+-antiporter system influence the skin pH by
H lesions [18]: Even though 97% of comedones con-
regulating the H+-concentration [8] .
(IV) Urocanic acid generated from the histi-
dine metabolism might also add to the acidic pool
[9].
Barrier Function
Formation and processing of lamellar structures
within the intercellular space of the stratum
corneum occur in an acidic environment [10].
Acidification improves stratum corneum struc-
ture and function. Therefore, skin surface acid-
ification has been hypothesized as a therapeutic
strategy for inflammatory dermatoses [10]. In
contrast, an increased skin surface pH activates
serine proteases, involved in the degradation of
corneodesmosomes [3, 11]. Disturbances of the
epidermal barrier in acne vulgaris is accompa-
nied by hyperkeratosis of the follicular epithe-
lium [12]. Compared to normal controls, pa-
tients with acne vulgaris reveal not only an im-
paired skin barrier function but also a reduction
of ceramides.
116
Surber C, Abels C, Maibach H (eds): pH of the Skin: Issues and Challenges.
Curr Probl Dermatol. Basel, Karger, 2018, vol 54, pp 115–122 (DOI: 10.1159/000489525)
Acne with and without Propionibacterium
acnes
An acidic pH allows the resident flora to grow. As
the pH increases, the resident flora changes [13].
In particular, Propionibacterium acnes grows well
in an environment with a pH range of 6.0–6.5;
however, when pH drops to 5.5, its growth notice-
ably decreases [14]. P. acnes stimulate keratino-
cytes to express and secrete IGF-1 and IGF-1R,
inducing proliferation and differentiation in ke-
ratinocytes and sebocytes. P. acnes play a signifi-
cant role in the formation of comedones [15]. P.
acnes, secreting lipases, proteases, hyaluronidases
and chemotactic factors induce monocytes, sebo-
cytes and keratinocytes to produce pro-inflam-
matory cytokines, such as interleukin (IL)-1α [16,
17]. Further studies reveal no clear evidence of P.
acnes involvement in comedones and inflamed
tain microorganisms, there is no significant cor-
relation between levels of IL-1α and the numbers
of microorganisms. Shaheen and Gonzalez [18]
suggest an imbalance between the pro- and anti-
inflammatory pathways for the initiation of in-
flamed acne lesions. Hypercornification of the in-
fundibulum has been initiated by IL-1α in vitro
[19]. An increase in epidermal IL-1α was ob-
served in mice after experimental barrier distur-
bances via tape stripping [20]. IL-1α produced af-
ter barrier disruption may initiate a cytokine cas-
cade, which could regulate cytokines and cytokine
receptor production and/or inflammatory re-
sponses. Thus, IL-1α seems to initiate inflamma-
tion in acne independent of the presence of P.
acnes.
P. acnes possess lipolytic activities, liberating
FFA from sebaceous lipids, although genuine
FFA production by human sebocytes is also pos-
sible [21, 22]. Some middle- to long-chain FFAs
(C8–C18) reveal antibacterial activity against
gram-positive bacteria. These FFAs may direct
antimicrobial activity against pathogen coloniza-
tion and infection and stimulate the expression of
129.187.254.46 - 8/22/2018 10:32:17 AM
Univ.-Bibliothek der TU München
Schürer
Downloaded by:
the antimicrobial peptide (AMP) hBD-2 in sebo-
cytes [7]. AMPs in turn have pH-dependent anti-
microbial characteristics. Some of these mole-
cules exhibit high pH optima for their antimicro-
bial activity, but most AMPs show activity against
microbes in acidic environment, which reflects
the importance of an acidic pH [23]. P. acnes met-
abolic activity linked to follicular stratum corne-
um pH may provide the reason why one follicle
may develop into an acne lesion, while adjacent
follicles do not.
Skin Surface pH and Acne
It is still unclear if the incidence of acne is higher
in patients revealing an increased skin surface
pH. There is only one study showing a positive
correlation: Prakash et al. [24] measured facial
skin pH in 200 patients with acne and in 200 age-
and sex-matched healthy controls: the mean pH
value in the healthy control group was within the
normal range. Compared to the control group,
the skin surface pH was significantly increased in
patients with acne.
Other studies did not reveal such clear correla-
tion between acne and the skin surface pH. Hol-
land and Cunliffe [25] suggested that the pH of
comedones and normal skin surface is similar.
Youn et al. [26] measured the skin surface pH of
the face in 540 patients with facial acne. In most
facial areas, the skin surface pH did not correlate
with the number of acne lesions in both genders.
A similar study had been performed by Kim et al.
[27] measuring the facial skin surface pH of 37
acne patients compared to 47 healthy individuals.
No difference  in skin surface pH could be re-
trieved in both groups.
However, the authors state that the pH level
was within normal range on the face from 5.4 to
5.9 [26]. According to a multicenter study, the
natural skin surface pH on the volar forearm is on
average below 5 [5] and the pH range on the fore-
head is comparable to that of the forearm [28]. In
pH and Acne
Surber C, Abels C, Maibach H (eds): pH of the Skin: Issues and Challenges.
Curr Probl Dermatol. Basel, Karger, 2018, vol 54, pp 115–122 (DOI: 10.1159/000489525)
accordance to these studies, an average pH >5 is
not within the normal range. To answer the ques-
tion about a possible correlation between the stra-
tum corneum (follicular) pH and acne, a consen-
sus on the applied methodology is as necessary as
a clear definition of the normal skin surface pH.
Acne and Skin Surface pH Influences
Influences on the skin surface pH may take an en-
dogenous and/or exogenous pathway. Further,
the skin surface pH may be altered depending
upon the disease status of the skin.
Endogenous influences include
1. Age
2. Gender
3. Fitzpatrick skin type
4. Sebum activity
5. Anatomical site
6. Skin moisture and sweat gland activity
(1) Under physiological conditions, skin
surface pH is maintained in the acidic range
throughout adult life, until old age when it rises
again [28–31]. Acne occurs during adolescence
(about 4/5) and in adult life (about 1/5) [32], that
is, during a life time when the skin surface pH is
constantly low.
(2) The majority of studies reveal a higher
facial skin surface pH in women compared to
men [26, 27, 33, 34]. Moreover, adult acne is more
common in women than in men [32]. Contrary to
the above-mentioned studies, a lower skin surface
pH has been found in females compared to males
in a study on 11 subjects [35]. Exogenous factors
influencing the skin surface pH as well as meth-
odological differences must be taken into account
when studies are compared.
(3) Humans with darkly pigmented skin dis-
play superior permeability barrier function com-
pared to humans with lightly pigmented skin [36,
37]. Superior permeability barrier function is
linked to the acidity of skin pH. Regardless of the
degree of pigmentation, acne vulgaris is one of the
129.187.254.46 - 8/22/2018 10:32:17 AM
Univ.-Bibliothek der TU München
117
Downloaded by:
most common cutaneous diseases, affecting up to
85% of adolescents. Prevalence data are available
from Australia, Brazil, China, Europe, India, USA
and Nigeria. All reveal comparable data with high
prevalence of acne in adolescents independent of
pigmentation skin type [38–43].
(4) Sebum secretion affects the skins surface
acidity. Facial sebum secretion and the skin sur-
face pH correlate [27]. This correlation however
does not apply to the back, most likely due to low-
er sebum secretion at this body site. Sebum pro-
duction is higher in men than that in women [44].
(5) The skin surface pH was measured on
the forehead, temple and forearm of female sub-
jects [28]: no difference in skin surface pH was
retrieved. In the intertriginous areas and regions
supplied by apocrine glands in the normal adult
skin, the pH is found to be less acidic or even neu-
tral [45]. The question arises whether there exists
a correlation between the “physiologic holes of
the acid mantle” in this region and the incidence
of hidradenitis suppurativa.
(6) The hydration values of the epidermis
depend on the anatomical area [46, 47]. Excessive
perspiration influences skin surface pH [48].
Sportive activity has been shown to increase the
skin surface pH with highest pH values measured
in armpits (pH 5.64–5.98) [49]. The effect of ex-
ercise-induced sweat on truncal acne was assessed
in a rather small, single-blinded, controlled, clin-
ical trial with 7, respectively 8 males per group
[50]. No significant differences in truncal acne
were noted in the exercising compared to the
non-exercising group.
Exogenous influences include
1. Rinse of products
2. Leave-on products
3. Environmental conditions
4. Nutritional factors.
(1) Rinse of products is classified according
to the type of surfactant used. The change in
skin pH is directly proportional to the pH of the
cleanser, and the effect is reversible [51, 52]. Re-
peated washes of acne using alkaline soaps will
118
Surber C, Abels C, Maibach H (eds): pH of the Skin: Issues and Challenges.
Curr Probl Dermatol. Basel, Karger, 2018, vol 54, pp 115–122 (DOI: 10.1159/000489525)
lead to an increase in skin surface pH and even-
tually to barrier disturbances. Therefore, alka-
line soaps are not the recommended cleansers
in acne.
(2) Although evidence is mounting for the
benefits of acidic emollients in maintaining bar-
rier homeostasis [10, 53], very little is known
about the pH of most available OTC leave-on
products. In a murine model, Hachem et al. [10]
showed positive influences of polyhydroxyl acids
on skin barrier function. The results are in accor-
dance with human studies [37, 54]. Furthermore,
repeated superficial chemical peels aligned with
home care products low in pH ≈3.8 have been
shown to be effective in reducing inflammatory
lesions of acne [55].
(3) It has been shown that exposure to solar
UV light compromises the skin’s barrier function
[56]. UV exposure has an additive effect to air-
borne pollutants and ozone. Exposure to some air
pollutants may also aggravate acne vulgaris [57].
(4) Nutritional optimization may not only
prevent skin disorders but may also improve skin
condition. The relationship between nutrition
and acne via high glycemic load diets has gained
interest [58]. Boelsma et al. [59] have shown in
302 subjects that an increase in serum vitamin A
is associated with a decrease in sebum content and
a decrease in surface pH. Melnik [60] correlates
the prevalence of adolescent acne with milk con-
sumption. The consumption of milk raises IGF-1
serum levels. IGF-1 is a potent mitogen, inducing
cell proliferation. The prevalence of acne in milk-
consuming societies can be explained by the IGF-
1-stimulation of sebaceous glands. Nutrition may
influence skin surface pH and/or acne.
Acne Treatment with Respect to Skin Surface
pH
Topical acne therapies can have a negative im-
pact on the epidermal barrier [61, 62]. These
studies as well as appropriate humectants and
129.187.254.46 - 8/22/2018 10:32:17 AM
Univ.-Bibliothek der TU München
Schürer
Downloaded by:
emollients to mitigate this problem have been re-
viewed in [63]. Epidermal barrier repair is sup-
ported in an acid environment; therefore, it is not
surprising that the extent of acne lesions can be
improved by acidification of the skin  surface.
Schurer and Bock [64] reported on a skin surface
pH-lowering devise: decreasing the pH of inflam-
matory acne lesions  correlated  with the clinical
extent of acne.
A series of superficial chemical peels can im-
prove acne over a short period of time, leading to
patient satisfaction and maintenance of clinical
results. The most commonly used chemical peels
in treating acne include salicylic acid and
α-hydroxy acids.
Glycolic acid is an α-hydroxy acid widely
used as a superficial peeling agent [55]. Expo-
sure of skin to glycolic acid leads to reduced cor-
neocyte adhesion, correction of abnormal infun-
dibular keratinization, decreased keratinocyte
plugging and ultimately decreased follicular oc-
clusion [65]. Chemical peels with 35% glycolic
acid (pH 1.2) decreased the number of propioni-
bacteria on the cheeks of patients significantly
[65].
The mode of action of a 4% glycolic acid for-
mulation (pH 3.8) on the stratum corneum was
investigated by electron microscopy [66]. Com-
pared to normal human stratum corneum, en-
hanced desmosomal breakdown was restricted to
the stratum disjunctum in the treated skin sites. A
more compact stratum corneum correlated with
unchanged TEWL in glycolic acid- versus vehi-
cle-treated skin [66]. However, glycolic acid peels
(30, 50, and 70%) on the volar forearm revealed
disturbances in barrier function, which recovered
within 24 h after the peel [67].
Salicylic acid is a beta-hydroxy acid. Due to its
lipophilicity, it penetrates well into the piloseba-
ceous unit. This property of salicylic acid ac-
counts for its comedolytic effect and its utility in
the treatment of acne. The safety and efficacy of
30% salicylic acid for the treatment of acne has
been demonstrated [68].
pH and Acne
Surber C, Abels C, Maibach H (eds): pH of the Skin: Issues and Challenges.
Curr Probl Dermatol. Basel, Karger, 2018, vol 54, pp 115–122 (DOI: 10.1159/000489525)
A review on the efficacy of glycolic acid (30–
70%) compared to salicylic acid (30%) peels on
inflammatory acne lesions has been recently pub-
lished [55]. Superficial chemical peels employing
glycolic acid (30–70%) and salicylic acid (30%)
are effective in reducing inflammatory lesions of
acne.
The use of a series of superficial chemical peels
along with homecare products adjusted to an
acidic pH seems to be a convenient, affordable
treatment for acne. However, most published
clinical trials (1) include only small numbers of
volunteers and (2) are open label and uncon-
trolled studies [69].
Conclusion
The literature reveals many studies on skin sur-
face acidification and epidermal barrier function.
Results are uniform: an acidic pH improves epi-
dermal barrier structure and function.
Acne is an inflammatory disease. Inflamma-
tion is initiated by IL-1α, perhaps due to the pres-
ence of P. acnes. There are few studies on the epi-
dermal barrier function in acne patients. Howev-
er, based on the current literature, acne vulgaris
may be associated with impaired water barrier
function, contributing to comedogenesis and in-
flammation. More controlled clinical and func-
tional studies are required.
Skin surface acidification may be a therapeu-
tic strategy for the treatment of acne. Skin care
with glycolic acid formulation (pH 3.8) does not
disrupt barrier structures. In contrast to acidic
skin care formulations, glycolic acid peels lead
temporarily to disturbances in barrier function,
recovering within 24 h after the peel. Even
though all clinical studies underline the efficacy
of superficial peels in mild-moderate acne, con-
trolled and larger studies are required. Is there a
correlation between the stratum corneum pH
and acne? This question remains unanswered as
yet. Published data are contradictory, possibly
129.187.254.46 - 8/22/2018 10:32:17 AM
Univ.-Bibliothek der TU München
119
Downloaded by:
because the following influences on acne and
skin surface pH need more attention: gender,
pigmentation, sebum gland activity, hydration,
anatomical region, nutrition, UV light and/or
airborne pollutants.
Last but not least, an acne patient should be
able to access not only the INCI (Internation-
al  Nomenclature of Cosmetic Ingredients)
of  a  given leave-on product but also its pH
range.

References
1 Behne MJ, Barry NP, Hanson KM, et al:
Neonatal development of the stratum
corneum pH gradient: localization and
mechanisms leading to emergence of
optimal barrier function. J Invest Der-
matol 2003;120:998–1006.
2 Ohman H, Vahlquist A: In vivo studies
concerning a pH gradient in human
stratum corneum and upper epidermis.
Acta Derm Venereol 1994;74:375–379.
3 Hachem JP, Crumrine D, Fluhr J, Brown
BE, Feingold KR, Elias PM: pH directly
regulates epidermal permeability barrier
homeostasis, and stratum corneum in-
tegrity/cohesion. J Invest Dermatol
2003;121:345–353.
4 Schmid-Wendtner MH, Korting HC:
The pH of the skin surface and its im-
pact on the barrier function. Skin Phar-
macol Physiol 2006;19:296–302.
5 Lambers H, Piessens S, Bloem A, Pronk
H, Finkel P: Natural skin surface pH is
on average below 5, which is beneficial
for its resident flora. Int J Cosmet Sci
2006;28:359–370.
6 Fluhr JW, Kao J, Jain M, Ahn SK, Fein-
gold KR, Elias PM: Generation of free
fatty acids from phospholipids regulates
stratum corneum acidification and in-
tegrity. J Invest Dermatol 2001;117:44–
51.
7 Nakatsuji T, Kao MC, Zhang L, Zoubou-
lis CC, Gallo RL, Huang CM: Sebum free
fatty acids enhance the innate immune
defense of human sebocytes by upregu-
lating beta-defensin-2 expression. J In-
vest Dermatol 2010;130:985–994.
8 Behne MJ, Meyer JW, Hanson KM, et al:
NHE1 regulates the stratum corneum
permeability barrier homeostasis. Mi-
croenvironment acidification assessed
with fluorescence lifetime imaging. J
Biol Chem 2002;277:47399–47406.
9 Fluhr JW, Elias PM, Man MQ, et al: Is
the filaggrin-histidine-urocanic acid
pathway essential for stratum corneum
acidification? J Invest Dermatol 2010;
130:2141–2144.
10 Hachem JP, Roelandt T, Schurer N, et al:
Acute acidification of stratum corneum
membrane domains using polyhydroxyl
acids improves lipid processing and in-
hibits degradation of corneodesmo-
somes. J Invest Dermatol 2010;130:500–
510.
11 Voegeli R, Rawlings AV, Doppler S, Hei-
land J, Schreier T: Profiling of serine
protease activities in human stratum
corneum and detection of a stratum
corneum tryptase-like enzyme. Int J
Cosmet Sci 2007;29:191–200.
12 Yamamoto A, Takenouchi K, Ito M: Im-
paired water barrier function in acne
vulgaris. Arch Dermatol Res 1995;287:
214–218.
13 Greenman J: Follicular pH and the de-
velopment of acne. Int J Dermatol 1981;
20:656–658.
14 Korting HC, Lukacs A, Vogt N, Urban J,
Ehret W, Ruckdeschel G: Influence of
the pH-value on the growth of Staphylo-
coccus epidermidis, Staphylococcus au-
reus and Propionibacterium acnes in
continuous culture. Zentralbl Hyg Um-
weltmed 1992;193:78–90.
15 Isard O, Knol AC, Aries MF, et al: Propi-
onibacterium acnes activates the IGF-1/
IGF-1R system in the epidermis and
induces keratinocyte proliferation. J
Invest Dermatol 2011;131:59–66.
16 Thiboutot DM, Layton AM, Anne Eady
E: IL-17: a key player in the P. acnes
inflammatory cascade? J Invest Derma-
tol 2014;134:307–310.
17 Kistowska M, Gehrke S, Jankovic D, et
al: IL-1beta drives inflammatory re-
sponses to propionibacterium acnes in
vitro and in vivo. J Invest Dermatol
2014;134:677–685.
18 Shaheen B, Gonzalez M: Acne sans P.
acnes. J Eur Acad Dermatol Venereol
2013;27:1–10.
19 Guy R, Green MR, Kealey T: Modeling
acne in vitro. J Invest Dermatol 1996;
106:176–182.
20 Wood LC, Elias PM, Calhoun C, Tsai JC,
Grunfeld C, Feingold KR: Barrier dis-
ruption stimulates interleukin-1 alpha
expression and release from a pre-
formed pool in murine epidermis. J In-
vest Dermatol 1996;106:397–403.
21 Zouboulis CC: Acne and sebaceous
gland function. Clin Dermatol 2004;22:
360–366.
22 Zouboulis CC, Seltmann H, Neitzel H,
Orfanos CE: Establishment and charac-
terization of an immortalized human
sebaceous gland cell line (SZ95). J Invest
Dermatol 1999;113:1011–1020.
23 Malik E, Dennison SR, Harris F, Phoenix
DA: pH dependent antimicrobial pep-
tides and proteins, their mechanisms of
action and potential as therapeutic
agents. Pharmaceuticals (Basel) 2016;
9:pii:E67.
24 Prakash C, Bhargava P, Tiwari S, Ma-
jumdar B, Bhargava RK: Skin surface pH
in acne vulgaris: insights from an obser-
vational study and review of the litera-
ture. J Clin Aesthet Dermatol 2017;10:
33–39.
25 Holland DB, Cunliffe WJ: Skin surface
and open comedone pH in acne pa-
tients. Acta Derm Venereol 1983;63:
155–158.
26 Youn SH, Choi CW, Choi JW, Youn SW:
The skin surface pH and its different
influence on the development of acne
lesion according to gender and age. Skin
Res Technol 2012;19:131–136.
27 Kim MK, Choi SY, Byun HJ, et al: Com-
parison of sebum secretion, skin type,
pH in humans with and without acne.
Arch Dermatol Res 2006;298:113–119.
129.187.254.46 - 8/22/2018 10:32:17 AM
Univ.-Bibliothek der TU München

120 Schürer
Downloaded by:

Surber C, Abels C, Maibach H (eds): pH of the Skin: Issues and Challenges.

Curr Probl Dermatol. Basel, Karger, 2018, vol 54, pp 115–122 (DOI: 10.1159/000489525)
28 Schreml S, Zeller V, Meier RJ, et al: Im-
pact of age and body site on adult female
skin surface pH. Dermatology 2012;224:
66–71.
29 Man MQ, Xin SJ, Song SP, et al: Varia-
tion of skin surface pH, sebum content
and stratum corneum hydration with
age and gender in a large Chinese popu-
lation. Skin Pharmacol Physiol 2009;22:
190–199.
30 Choi EH, Man MQ, Xu P, et al: Stratum
corneum acidification is impaired in
moderately aged human and murine
skin. J Invest Dermatol 2007;127:2847–
2856.
31 Fluhr JW, Pfisterer S, Gloor M: Direct
comparison of skin physiology in chil-
dren and adults with bioengineering
methods. Pediatr Dermatol 2000;17:
436–439.
32 Dreno B: Bacteriological resistance in
acne: a call to action. Eur J Dermatol
2016;26:127–132.
33 Jacobi U, Gautier J, Sterry W, Lademann
J: Gender-related differences in the
physiology of the stratum corneum.
Dermatology 2005;211:312–317.
34 Kim MK, Patel RA, Shinn AH, et al:
Evaluation of gender difference in skin
type and pH. J Dermatol Sci 2006;41:
153–156.
35 Ehlers C, Ivens UI, Moller ML, Sendero-
vitz T, Serup J: Females have lower skin
surface pH than men. A study on the
surface of gender, forearm site variation,
right/left difference and time of the day
on the skin surface pH. Skin Res Tech-
nol 2001;7:90–94.
36 Man MQ, Lin TK, Santiago JL, et al: Ba-
sis for enhanced barrier function of pig-
mented skin. J Invest Dermatol 2014;
134:2399–2407.
37 Gunathilake R, Schurer NY, Shoo BA, et
al: pH-regulated mechanisms account
for pigment-type differences in epider-
mal barrier function. J Invest Dermatol
2009;129:1719–1729.
38 Bagatin E, Timpano DL, Guadanhim LR,
et al: Acne vulgaris: prevalence and clin-
ical forms in adolescents from Sao Pau-
lo, Brazil. An Bras Dermatol 2014;89:
428–435.
39 Shen Y, Wang T, Zhou C, et al: Preva-
lence of acne vulgaris in Chinese adoles-
cents and adults: a community-based
study of 17,345 subjects in six cities.
Acta Derm Venereol 2012;92:40–44.
pH and Acne
Surber C, Abels C, Maibach H (eds): pH of the Skin: Issues and Challenges.
Curr Probl Dermatol. Basel, Karger, 2018, vol 54, pp 115–122 (DOI: 10.1159/000489525)
40 Yahya H: Acne vulgaris in Nigerian ado-
lescents – prevalence, severity, beliefs,
perceptions, and practices. Int J Derma-
tol 2009;48:498–505.
41 Cunliffe WJ, Gould DJ: Prevalence of
facial acne vulgaris in late adolescence
and in adults. Br Med J 1979;1:1109–
1110.
42 Davis EC, Callender VD: A review of
acne in ethnic skin: pathogenesis, clini-
cal manifestations, and management
strategies. J Clin Aesthet Dermatol 2010;
3:24–38.
43 Perkins AC, Cheng CE, Hillebrand GG,
Miyamoto K, Kimball AB: Comparison
of the epidemiology of acne vulgaris
among Caucasian, Asian, Continental
Indian and African American women. J
Eur Acad Dermatol Venereol 2011;25:
1054–1060.
44 Giacomoni PU, Mammone T, Teri M:
Gender-linked differences in human
skin. J Dermatol Sci 2009;55:144–149.
45 Chikakane K, Takahashi H: Measure-
ment of skin pH and its significance in
cutaneous diseases. Clin Dermatol 1995;
13:299–306.
46 Tagami H: Location-related differences
in structure and function of the stratum
corneum with special emphasis on those
of the facial skin. Int J Cosmet Sci 2008;
30:413–434.
47 Black D, Del Pozo A, Lagarde JM, Gall Y:
Seasonal variability in the biophysical
properties of stratum corneum from
different anatomical sites. Skin Res
Technol 2000;6:70–76.
48 Wang S, Zhang G, Meng H, Li L: Effect
of exercise-induced Sweating on facial
sebum, stratum corneum hydration, and
skin surface pH in normal population.
Skin Res Technol 2013;19:e312–e317.
49 Luebberding S, Kolbe L, Kerscher M:
Influence of sportive activity on skin
barrier function: a quantitative evalua-
tion of 60 athletes. Int J Dermatol 2013;
52:745–749.
50 Short RW, Agredano YZ, Choi JM, Kim-
ball AB: A single-blinded, randomized
pilot study to evaluate the effect of exer-
cise-induced sweat on truncal acne. Pe-
diatr Dermatol 2008;25:126–128.
51 Gunathilake HM, Sirimanna GM, Sch-
urer NY: The pH of commercially avail-
able rinse-off products in Sri Lanka and
their effect on skin pH. Ceylon Med J
2007;52:125–129.
52 Aßmus U, Banowski B, Brock M, et al:
Impact of cleansing products on the skin
surface pH. IFSCC Magazine 2013;1:
17–24.
53 Breternitz M, Flach M, Prassler J, Elsner
P, Fluhr JW: Acute barrier disruption by
adhesive tapes is influenced by pressure,
time and anatomical location: integrity
and cohesion assessed by sequential
tape stripping. A randomized, con-
trolled study. Br J Dermatol 2007;156:
231–240.
54 Blaak J, Kaup O, Hoppe W, et al: A long-
term study to evaluate acidic skin care
treatment in nursing home residents:
impact on epidermal barrier function
and microflora in aged skin. Skin Phar-
macol Physiol 2015;28:269–279.
55 Al-Talib H, Al-Khateeb A, Hameed A,
Murugaiah C: Efficacy and safety of su-
perficial chemical peeling in treatment
of active acne vulgaris. An Bras Derma-
tol 2017;92:212–216.
56 Biniek K, Levi K, Dauskardt RH: Solar
UV radiation reduces the barrier func-
tion of human skin. Proc Natl Acad Sci
U S A 2012;109:17111–17116.
57 Krutmann J, Moyal D, Liu W, et al: Pol-
lution and acne: is there a link? Clin
Cosmet Investig Dermatol 2017;10:199–
204.
58 Liakou AI, Theodorakis MJ, Melnik BC,
Pappas A, Zouboulis CC: Nutritional
clinical studies in dermatology. J Drugs
Dermatol 2013;12:1104–1109.
59 Boelsma E, van de Vijver LP, Goldbohm
RA, Klopping-Ketelaars IA, Hendriks
HF, Roza L: Human skin condition and
its associations with nutrient concentra-
tions in serum and diet. Am J Clin Nutr
2003;77:348–355.
60 Melnik B: Milk consumption: aggravat-
ing factor of acne and promoter of
chronic diseases of Western societies. J
Dtsch Dermatol Ges 2009;7:364–370.
61 Stucker M, Hoffmann M, Altmeyer P:
Instrumental evaluation of retinoid-in-
duced skin irritation. Skin Res Technol
2002;8:133–140.
62 Herane MI, Fuenzalida H, Zegpi E, et al:
Specific gel-cream as adjuvant to oral
isotretinoin improved hydration and
prevented TEWL increase – a double-
blind, randomized, placebo-controlled
study. J Cosmet Dermatol 2009;8:181–
185.
129.187.254.46 - 8/22/2018 10:32:17 AM
Univ.-Bibliothek der TU München
121
Downloaded by:
63 Jordan L, Baldwin HE: Stratum corneum
abnormalities and disease-affected skin:
strategies for successful outcomes in
inflammatory acne. J Drugs Dermatol
2016;15:1170–1173.
64 Schurer NY, Bock M: Lowering lesional
surface pH in acne: a new treatment
modality for Herpifix. J Dermatolog
Treat 2009;20:27–31.
65 Takenaka Y, Hayashi N, Takeda M,
Ashikaga S, Kawashima M: Glycolic acid
chemical peeling improves inflamma-
tory acne eruptions through its inhibi-
tory and bactericidal effects on Propi-
onibacterium acnes. J Dermatol 2012;
39:350–354.
66 Fartasch M, Teal J, Menon GK: Mode of
action of glycolic acid on human stra-
tum corneum: ultrastructural and func-
tional evaluation of the epidermal bar-
rier. Arch Dermatol Res 1997;289:
404–409.
67 Song JY, Kang HA, Kim MY, Park YM,
Kim HO: Damage and recovery of skin
barrier function after glycolic acid
chemical peeling and crystal micro-
dermabrasion. Dermatol Surg 2004;30:
390–394.
68 Dainichi T, Ueda S, Imayama S, Furue
M: Excellent clinical results with a new
preparation for chemical peeling in
acne: 30% salicylic acid in polyethylene
glycol vehicle. Dermatol Surg 2008;34:
891–899; discussion 899.
69 Dreno B, Fischer TC, Perosino E, et al:
Expert opinion: efficacy of superficial
chemical peels in active acne manage-
ment – what can we learn from the lit-
erature today? Evidence-based recom-
mendations. J Eur Acad Dermatol
Venereol 2011;25:695–704.

Prof. Dr. Nanna Schürer

Department of Dermatology, Environmental Medicine and Health Theory
Faculty of Human Sciences, University of Osnabrück
Am Finkenhügel 7a
DE–49076 Osnabrück (Germany)
E-Mail nschuere@uos.de
129.187.254.46 - 8/22/2018 10:32:17 AM
Univ.-Bibliothek der TU München

122 Schürer
Downloaded by:

Surber C, Abels C, Maibach H (eds): pH of the Skin: Issues and Challenges.

Curr Probl Dermatol. Basel, Karger, 2018, vol 54, pp 115–122 (DOI: 10.1159/000489525)