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Minnesota recently mades the news for banning Triclosan, an antibacterial agent used in handwashes, due to potential health risks. (This question is not about those risks.)

Those risks must be balanced with the potential for health gains. When it comes to hand-washes, FDA reports:

At this time, the agency does not have evidence that triclosan in antibacterial soaps and body washes provides any benefit over washing with regular soap and water.

(That statement was last updated November 2013.)

This is inconsistent with my doctor's advice (from two decades ago) and my anecdotal experience that triclosan-based antibacterial hand-washes are efficacious at clearing minor skin infections.

Is the use of Triclosan to treat skin infections evidence-based? Have I been treating myself with a placebo?

[For completeness, the US EPA also has concerns.]

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    If you count surgical site infections, there seems to be evidence that triclosan-coated sutures at least help prevent infection. However, this study is much more recent than "decades ago", so I don't know if there was evidence for it at the time.
    – Is Begot
    May 23, 2014 at 13:39
  • @Geobits: Hmm... You raise a few issues. I don't think it would be reasonable for me to ask "was it evidence-based when the recommendation happened?" The question has to be "according to current evidence".
    – Oddthinking ♦
    May 23, 2014 at 14:38
  • I guess my question summarises to "According to current evidence, if you have a mild skin infection, is the use of triclosan hand-washes better at clearing it up than soap and water, excluding the factors of prevention, environmental impact (including breeding resistance) and the claimed long-term health risks?"
    – Oddthinking ♦
    May 23, 2014 at 14:40
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    You could probably also find that claim made somewhere by manufacturers of triclosan-based sanitizers, but I'm not 100% certain. Most of the time I just see a broad "kills germs!" sticker on it.
    – Is Begot
    May 23, 2014 at 14:41
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    Here's a claim it works to treat infections, with lots of warnings that it may have downsides, maybe.
    – Oddthinking ♦
    May 23, 2014 at 15:55

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In the past, Triclosan has been found to reduce the level of bacteria on the skin, as per a set of two 1987 trials, when used after mechanical washing with a bar of soap. Since then, numerous trials have demonstrated that, although it is efficacious in certain situations, the initial conclusions concerning skin infections may have been presumptuous. This is also related to a trend in pharmaceuticals towards proving not only efficacy overall, but efficacy compared to other available products. So overall, yes the initial use two decades ago would have been evidence based, but current evidence points to other products being just as effective but with fewer possible adverse effects. The reason for this discrepancy overall is basically understood to be that a reduction in bacteria on the skin, which is what the 1987 trials were able to demonstrate, does not necessarily equate to superior clinical outcomes.

Initial 1987 studies: http://www.jstor.org/discover/10.2307/30145125?uid=3739896&uid=2&uid=4&uid=3739256&sid=21104062128617 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2235365/

Subsequent studies demonstrating lack of efficacy: http://cid.oxfordjournals.org/content/45/Supplement_2/S137.long

FDA policy release statement December 2013 changing policies related to standards for efficacy: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm378542.htm

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