The number of propionibacteria on the skin surface is increased by soap and decreased by synthetic detergents.23 This may be due to the changes in skin pH, which is increased by soap.23 There is no evidence either for or against the use of abrasive agents either alone or in combination with topical treatments. There is evidence to suggest that antibacterial skin cleansers may be effective in the management of mild acne,17 and may produce similar outcomes to benzoyl peroxide in moderate acne.20 However, the long-term benefits of "step-up" management strategies versus aggressive therapy from onset have not been examined. There is no evidence that antibacterial cleansers offer additional benefits when used in conjunction with oral antibiotics in individuals with more severe acne, but they may help maintain improvement following termination of antibiotic therapy.19 The impact of increased contact time during washing has not been examined.
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