Face and body sponges: beauty aids or potential microbiological reservoir?

ARTICLE

Auteur(s) : Monica CORAZZA¹, Elide CARLA¹, Maria Rita ROSSI², Maria Federica PEDNA², Annarosa VIRGILI¹

¹ Dipartimento di Medicina Clinica e Sperimentale, Sezione di Dermatologia, Università di Ferrara, Via Savonarola 9, 44100 Ferrara, Italy
² Laboratorio Analisi Chimico-Cliniche e Microbiologia, Azienda Arcispedale S. Anna, Ferrara, Italy

Article accepted on 9/09/2003

Small sponges made of cellulose or nylon are commonly used in daily hygiene as exfoliative beauty aids and in removing make-up. After use, these sponges are generally cleansed under running water and re-utilized.
We have recently observed a relapsing folliculitis of the trunk and limbs in a woman and her daughter who had the habit of using the same nylon sponge in the bathroom. In both patients cultural examination after a cutaneous swab showed that the folliculitis was caused by Pseudomonas aeruginosa and Klebsiella pneumoniae. The same bacteria were found on cultural examination of the nylon sponge.
Similar sporadic cases of folliculitis, after the use of natural [1-3] and synthetic sponges [4-6] are reported in the literature. They are mostly caused by Gram-negative bacteria (above all Pseudomonas aeruginosa). Gram-negative bacteria and especially Pseudomonas aeruginosa are ubiquitous but show a predilection for moist areas of human skin and easily develop in closed-cycle water sources like whirlpools and small swimming-pools [7, 8].
The aim of our study was to evaluate the development of potential pathogenic bacteria after the daily use of cellulose and nylon sponges by healthy people.

Materials and methods

25 cellulose sponges for removing face make-up and 25 nylon sponges, of the kind commonly used for performing superficial peeling and massage to remove superficial epithelial cells during showering and bathing, were purchased. 25 women, mean age 44 (range 22-71) were consecutively selected. Each woman was healthy and was free from any dermatological disease. They were instructed to use a cellulose face sponge and a nylon body sponge daily for a month, without taking any special sanitary precaution and keeping them in the shower-box. All the women were provided with the sponges and the same soap without antiseptics.

Before starting the study, a sample of 10 new cellulose sponges and 5 new nylon sponges was tested for their bacterial baseline population. This was performed by inoculating sponge fragments, standardized in dimensions (6 mm punch) in thioglycolate broth (Sclavo) for 18 hours at 36 °C.

The thioglycolate broth was then inoculated in: 5% sheep blood agar base (Bio-Merieux) (generic medium for bacteria and yeasts), Mac Conkey agar (Bio-Merieux) (specific medium for Enterobacteriaceae, Pseudomonaceae and Gram negative non fermenting rods) and mannitol salt-agar (specific medium for Staphylococci, Bio-Merieux). The tube coagulase test (DID) was utilized to differentiate Staphylococcus aureus from Staphylococcus epidermidis. Furthermore, systems for biochemical identification of Enterobacteriaceae, non fermenters and Gram negative bacteria were carried out: API 32E system and API 20NE system (Bio-Merieux). Bacillus spp. was identified by Gram stain set and catalase test (Becton Dickinson).

After one month of use all the cellulose and nylon sponges were collected. Again, fragments from each sponge, obtained with a sterile 6 mm punch, were submitted to the previously described bacteriological investigations.

Results

Only colonies of Bacillus spp. and Staphylococcus epidermidis were found in the sample of 10 cellulose face sponges and 5 nylon body sponges never previously used.
After use, a wide variety of bacterial species was detectable in the cellulose face sponges (Fig. 1) and in the nylon body sponges (Fig. 2). The most common were Staphylococcus epidermidis and Staphylococcus aureus, but there was also a notable presence of Gram negative species; 32 isolations out of 50 in the face sponges (64%) and 25 isolations out of 48 in the body sponges (52%) were Gram negative bacteria (mostly Enterobacter cloacae and Escherichia coli).

Discussion

Synthetic and natural sponges are beauty aids, produced in a wide variety of size and shapes, designed to remove make-up or superficial epithelial cells during bathing and showering.
In our experience, as previously reported by other studies, cellulose and nylon sponges before use are frequently sterile or contain a limitated bacterial flora consisting only of Bacillus spp. and Staphylococcus epidermidis [1, 9].
In our study, after a one-month period of use, bacterial species of environmental origin, belonging prevalently to the Enterobacteriaceae, Pseudomonaceae and Gram negative non fermenting rods, developed in cultures. The only true pathogenic bacterium found was Staphylococcus aureus; all the others were considered opportunistic pathogenic bacteria.
Matching the results of the Figures 1 and 2 it was evident that the most frequently found bacteria were the same in both kind of sponges; this observation seemed to demonstrate that the environment conditioned the bacterial growth more than the body area, even if the possibility of hand carry-over of bacteria should be taken in consideration.
The different material the sponges were made of (cellulose or nylon) did not seem to influence bacterial growth. In the literature microbiological studies performed on natural [1, 2, 8] and synthetic sponges [6], to assess them as reservoirs and vehicles in the transmission of potentially pathogenic bacterial species, have been reported; according to our experience bacterial growth is independent of the materials used in making sponges.
Environmental factors like humidity and high temperature favour bacterial growth; in normal use, people keep their sponges in the shower box and it is possible that the interval between showers is not sufficient to allow them to dry completely. Furthermore bacterial growth is favoured by the presence of soap and organic debris like desquamated epithelial cells entrapped in sponges.
The abrasive action of sponges may traumatize the epidermis and permit the cutaneous penetration of bacteria and development of skin infections like folliculitis due to Gram-negative bacteria and especially Pseudomonas aeruginosa [4-6, 8].
In conclusion, even in a healthy population, it is advisable that sponges be restricted to personal use, regularly washed, adequately dried, not kept in the showering area and, as some authors suggest, submitted to periodic 10% aqueous hypochlorite bleach decontamination [1, 8]. n

References

1. Bottone EJ, Perez II AA. Pseudomonas aeruginosa folliculitis acquired through use of a contaminated loofah sponge: an unrecognized potential public health problem. J Clin Microbiol 1993; 31: 480-3.

2. Scupham R, Fretzin D, Weinstein RA. Caribbean sponge-related Pseudomonas folliculitis. JAMA 1987; 258: 1607-8.

3. Fisher AA. Folliculitis from the use of a “loofah” cosmetic sponge. Cutis 1994; 54: 12-3.

4. Maniatis AN, Karkavitsas C, Maniatis NA et al. Pseudomonas aeruginosa folliculitis due to non-0:11 serogroups: acquisition through use of contaminated synthetic sponges. Clinical Infectious Diseases 1995; 21: 437-9.

5. Kitamura M, Kawai S, Horio T. Pseudomonas aeruginosa folliculitis: a sporadic case from use of a contaminated sponge. Br J Dermatol 1998; 139: 359-60.

6. Frenkel LM. Pseudomonas folliculitis from sponges promoted as beauty aids. J Clin Microbiol 1993; 31: 2838-9.

7. Berger RS, Seifert MR. Whirlpool folliculitis: a review of its cause, treatment, and prevention. Cutis 1990; 45: 97-8.

8. Zichichi L, Asta G, Noto G. Pseudomonas aeruginosa folliculitis after shower/bath exposure. International Journal of Dermatology 2000; 39: 270-3.

9. Bottone EJ, Perez II AA, Oeser JL. Loofah sponges as reservoirs and vehicles in the transmission of potentially pathogenic bacterial species to human skin. J Clin Microbiol 1994; 32: 469-72.