Veterinary Dermatology 2002, 13, 293 300

Review Article

Blackwell Science, Ltd

A comparative review of cutaneous pH

JENNIFER L. MATOUSEK and KAREN L. CAMPBELL
Veterinary Clinical Medicine, University of Illinois, Urbana, Illinois, USA
(Received 14 January 2002; accepted 9 July 2002)

Abstract This review describes the role of pH in cutaneous structure and function. We first describe the molecules that contribute to the acidity or alkalinity of the skin. Next, differences in cutaneous pH among species,
among individuals of the same species and within individuals are described. The potential functions of cutaneous
pH in normal and diseased skin are analysed. For example, cutaneous pH has a role in the selection and maintenance of the normal cutaneous microbiota. In addition, cutaneous acidity may protect the skin against infection
by microbes. Finally, there is evidence that a cutaneous pH gradient activates pH-dependent enzymes involved
in the process of keratinization.
Keywords: animal, comparative, cutaneous, human, review, skin pH

INTRODUCTION
The role cutaneous pH plays in the barrier function of
the skin has been a matter of debate for over a century.
Human skin pH is relatively acidic (4.04.9) compared
with the skin of many animal species (Table 1).15 Most
investigators believe that the acidity of human skin
serves to protect it from invasion by micro-organisms.6,7
More recent findings show that pH also influences
the permeability barrier of the skin and the normal
keratinization process.8,9 Information regarding
cutaneous pH in animals is sparse. The following is a
Table 1. Includes the average of reported cutaneous pH values
for several mammalian species. 4,6,20,24,25,2830,43 48 pH levels were
measured using different techniques, and may not be directly
comparable
Mammalian species

Average reported pH

Human
Guinea pig
Goat
Pig
Horse
Cat
Monkey
Rat
Cattle
Rabbit
Dog
Sheep

4.8
5.5
5.9
6.3
6.3
6.4
6.4
6.5
6.7
6.7
7.4
8.1

Correspondence: Jennifer L. Matousek, Veterinary Clinical

Medicine, University of Illinois, 1008 W. Hazelwood Drive, Urbana,
IL 61802, USA. Tel. +1-217-333-7768; Fax: +1-217-244-1475;
E-mail: jmatousek@cvm.uiuc.edu
2002 Blackwell Science Ltd

literature review of the origins of cutaneous pH, and

normal skin pH values in people and animals. In
addition, this review summarizes possible roles of pH
in normal and diseased skin.

ORIGINS OF CUTANEOUS PH
The symbol pH is used to indicate the potzen (German
for power) or concentration of hydrogen ion (H+) in a
solution. Specifically, pH represents the logarithmic
reciprocal of the H+ concentration (pH = log 1/H+).7,10
A pH of 7.0 is considered neutral. A pH of < 7.0 is
considered acidic, whereas a pH > 7.0 is considered
alkaline.11 Therefore, as the pH number increases, the
concentration of H+ (acidity) decreases. It is important
to remember that pH is measured on a logarithmic
scale with 10 as its base, which means that each change
of 1 pH unit corresponds to a 10-fold change in H+
concentration. The difference between a pH of 5.0 and
5.3 (0.5 105 gram ion per litre) is greater than the
difference between a pH of 7.0 and 7.3 (0.5 107 gram
ion per litre).10 In addition, because of the logarithmic
scale, the H+ concentration at a pH of 5.0, is twice that
at a pH of 5.3.10
The pH of the skin results from a combination of
factors derived from the epidermal cells and glands
(sebaceous, apocrine, eccrine). This buffering system of
acidic and alkaline molecules maintains the pH of the skin
within a normal range. Most information regarding
the origins of cutaneous pH is derived from studies in
people and rodents.
The original acid mantle theory proposed that a
surface film of molecules was responsible for cutaneous
acidity. Two methods have been used to show that the
293

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J.L. Matousek and K.L. Campbell

acidity of the skin extends beyond the superficial

lipid film, and into the stratum corneum. First, when
organic solvents are used to remove the lipid layer,
cutaneous pH is not affected.12 Second, tape stripping
methods demonstrate that a pH gradient extends from
the human stratum corneum ( 5.0) to the upper granular
layer ( 7.0).9, 12,13 With this method, layers of cells are
removed consecutively with pieces of tape, and the pH
of the remaining layers is measured with a flat glass
electrode. The amount of stratum corneum removed
varies with mammalian species, the type of tape used,
and the investigators techniques.9 A glistening appearance to the epidermis after tape stripping corresponds
with the granular layer histopathologically.9 Although
it is possible that trauma from the tape could cause
changes in pH (by diffusion of fluid to the surface), the
thinness of the stratum corneum makes other current
pH measurement techniques unrealistic.
In general, skin pH increases with increased numbers
of tape strips. The pH gradient is steepest in the area of
the stratum corneum directly above the granular layer.13
For example, in mice, no changes in pH were seen with
the first 15 tape strippings, but the pH increased from
5.9 to 7.0 with 5 additional tape strips.14 This gradient
may play an important role in the keratinization
process, by regulating the activity of pH-dependent
enzymes.
Molecules that contribute to the acidity of the skin
include filaggrin breakdown products (urocanic acid,
pyrrolidone carboxylic acid), and amino acids derived
from sweat, sebum and the stratum corneum.11,13,1518
In addition, acidic lipids such as cholesterol sulfate and
free fatty acids are present. These fatty acids may arise
from sebaceous secretions or through de novo synthesis
by bacterial degradation of sebum. Fatty acids are also
synthesized by the epidermis from phospholipids
during the terminal differentiation of keratinocytes.19
Alpha-hydroxy acids from sweat and other skin
components also contribute to an acidic pH. Examples
of these are lactic acid (can be decomposed into acetic
and proprionic acids) and butyric acid.15,16,20,21
Molecules that increase the alkalinity of the skin are
also present. One example is ammonia, which is produced
by the eccrine sweat gland.22,23 Carbon dioxide and
bicarbonate from sweat may also increase cutaneous
pH.20,24 Although the factors involved in maintaining
the pH of the skin are complex, the combination of these
acidic and alkaline molecules contributes to cutaneous
pH levels. The significance of individual molecules
involved in the formation of cutaneous pH levels is still
being elucidated.

NORMAL CUTANEOUS PH VALUES

Many different ranges are reported for cutaneous pH.
This diversity is likely due to several factors. First,
various techniques have been used to measure the pH
of the skin, including colorimetric indicators and
electrodes (gas chain bell, quinhydrone, glass).1,21,2426
2002 Blackwell Science Ltd, Veterinary Dermatology, 13, 293 300

Although quinhydrone and glass electrodes have been

shown to be equivalent, measurements with other
techniques (particularly colorimetric) are not directly
comparable.1,21 Second, cutaneous pH varies within
an individual, among individuals of the same species,
and between species.27
Human
In general, human skin pH is more acidic than the skin
of other mammalian species.4,25 The reported range
for normal human skin varies from an acidic pH of 3.0
to an almost neutral pH of 6.5.4,20,24,2830 A range of
4.04.9 is most common.13 The effects of age, gender,
race, anatomic location and environment on cutaneous
pH have been evaluated.
The skin of infants is less acidic to slightly more
alkaline (range of 6.77.5) than that of adults, and the
pH is significantly higher (mean 6.77) for the first 24 h
of life than it is for the following week.15,3133 The
exact cause of the increased pH levels in infants is not
known, but infants have lower amounts of free fatty
acids in epidermal lipids, and relatively high levels of
bicarbonate in eccrine sweat compared to adults.31,33
A sharp decrease in pH occurs within 48 h of birth, and
the skin gradually becomes more acidic throughout the
first month of life.15,3436 The development of cutaneous
acidity in very low birth weight neonates (premature
birth) parallels that of normal term infants, indicating
that the mechanism for this pH change is present
early in gestation.15,36 Green et al.36 reported that the
acidification process may be related to the clearance of
the fetal vernix caseosa (contains sebum and sloughed
epidermal cells). The cutaneous pH range in children
1 month to 12 years of age (range 4.06.0) is similar to
adults.21 It appears to remain constant until about
80 years of age, when slight increases in pH can be
identified on the cheek, forehead, and ankle.28,37
A few reports have indicated gender associations9,15,38
but these are not supported by other studies.4,28,37
Berardesca et al.39 reported that the skin of African
Americans has a tendency to be more acidic than that
of Caucasians.39 But, in their study, there were no
significant differences in pH measurements at baseline
or after 9, 12 or 15 tape strippings. The only significant
difference between the pH of black skin and white skin
occurred after three tape strippings, when the pH of
white skin was 4.8, and that of black skin was 4.3
(P < 0.05).
Cutaneous pH varies among different anatomic
locations. Areas that are occluded (axillae, genitoanal
region, intertriginous and interdigital) compared with
the rest of the body have a relatively higher pH.1,7,21,24
Goodman6 suggested that occlusion of skin areas does
not allow for proper evaporation of eccrine perspiration,
thus leading to an increased skin pH. The elevated pH
in occluded areas is paralleled by an increase in transepidermal water loss (TEWL) and stratum corneum
permeability.40
Increases in environmental temperature and relative
humidity can lead to increases in eccrine and apocrine

Cutaneous pH
sweating. These two types of sweat, and their respective
effects on the cutaneous pH, differ. Normal eccrine sweat
is acidic (4.56.0) and the skin becomes more acidic as
the sweat evaporates (normally ammonia evaporates
quickly).41 As the rate of eccrine sweat increases, the
concentrations of ammonia, pyruvic acid and lactate
decrease, and the pH increases.23,41 Thermal apocrine
sweat has a higher pH than eccrine sweat, and the skin
pH becomes higher as it evaporates.16,26,30
Abe et al.42 demonstrated a seasonal effect on cutaneous
pH. Measurements were taken in a nonair-conditioned
room, in which the temperature and relative humidity
was highest in July (27.5C, 70.5%) and lowest in January
(15.1C, 35.1%). There was an inverse relationship
between skin surface pH and environmental temperature the pH was the lowest in July. They proposed that
this change was due to an overall increase in eccrine
sweat production.
Yosipovitch et al.29 determined that circadian rhythms
in human skin pH are present on the forearm and shin,
but not on the forehead or back. In most of the people
studied, maximum pH levels occurred in the afternoon
(14.0016.00), and lowest levels occurred in the evening
(20.00). These results conflict with those of Ehlers
et al.38 who evaluated forearm pH from 08.00 to 15.00,
and showed a decrease in pH throughout the day, with
lowest values occurring at 15.00. The relevance of these
findings are uncertain. Yosipovitch et al.29 speculated
that the pH changes reflect circadian variation in stratum
corneum enzyme activities, but to date there are no
reports on the rhythmicity of enzyme function in the
epidermis. It is possible that circadian variations are
influenced by other factors, such as climate, physical
activity, age or previous soap use.
Canine
Canine skin pH differs from human skin, and tends to
be the highest of the mammalian species.25 Reports of
normal canine pH have ranged from 4.84 to 9.95.25,4345
Although many investigators indicate that the most
common pH range for canine skin is 5.57.2, it may
actually be higher. In a study by Ruedisueli et al.45 the
mean pH on the flanks of dogs was 7.48. The authors
have also observed a higher cutaneous pH range on the
dorsal thoracolumbar area of dogs (6.49.1).46
Previous researchers have not identified a significant
association between gender and skin pH in dogs43 but
Ruedisueli et al.45 reported that the cutaneous pH of
males was higher than females. In addition, the skin of
neutered female dogs was higher than that of intact
females.45 There is a significant difference in mean pH
related to dog breeds: Labrador Retriever (7.13),
Miniature Schnauzer (7.25), Springer Spaniel (6.65),
and Yorkshire Terrier (7.71) dogs.45 As in people, the
pH levels from different anatomic sites in dogs are
significantly different.45
Meyer et al.43 reported that excitement in dogs can
lead to elevations in cutaneous pH levels. The pH range
in unexcited dogs was 4.847.70, whereas that in excited
dogs was 6.609.95. They proposed that the elevation

295

was due to increased apocrine gland secretion. This

would be consistent with Roys study in which dogs with
hyperhidrosis (apocrine) had a more alkaline pH than
normal dogs, with a pH range of 8.29.0.44
Cattle
There are few reports of cutaneous pH ranges for
cattle. The lowest reported pH is 4.5, and the highest
is 8.8.43,47 A study of Aryshire cattle revealed a pH
range of 5.05.5 for most animals.47 In this study, skin
pH was not related to the contents of the animals
diet.47 As seen in people, age may have an effect on the
cutaneous pH in cattle. Aryshire calves tended to have
higher skin pH levels (mean 6.10) than adult Aryshire
cattle (mean 5.62).47
There may be a correlation between gender and
cutaneous pH values in cattle. Meyer et al.43 noted that
the skin of cows had a significantly lower pH (range
6.108.00) than that of male cattle (range 8.008.15).
There are two factors which may have affected their
results. First, a small number of male cattle (n = 4)
were used compared with the number of female cattle
(n = 28). Second, the hair was not clipped from the
skin where the pH measurements were taken. Nevertheless, a study of Aryshire cattle by Jenkinson et al.47
suggested that the skin of young heifers was more
acidic than that of male calves. Further studies should
be carried out using a larger and more diverse population of cattle.
In cattle, there is a significant difference in pH levels
between individuals, and between anatomic sites of an
individual. The area found to have the highest pH was
the muzzle, followed by the teat and udder.47 Although
variations occurred, there were no significant differences
among sites on haired skin.43,47 Duration of lactation
may affect cutaneous pH in cattle. Cows that were
lactating for fewer than six months had lower pH on
the haired skin than cattle that were lactating for more
than six months.47 Lactation may also affect udder pH.
Environmental factors also alter cutaneous pH in
cattle. Increased temperature (3840C) and relative
humidity led to increased sweat secretions in Aryshire
cattle, which corresponded with an increase in cutaneous
pH.47 The investigators proposed that the increased
alkalinity was due to increased secretion of alkaline
products, such as bicarbonate. Meyer et al.43 noted
that excitement and physical stress in cattle led to an
increase in cutaneous pH (1.02.0 units) within 12 min,
and believed that it was due to an increase in apocrine
gland secretion.
Other species
There are miscellaneous reports of normal cutaneous
pH in other species of mammals. Meyer et al.43 reported
that the cutaneous pH of cats ranged from 5.4 to 6.7.
Draize25 described similar results in cats, with a pH
range of 5.577.44 and an average skin pH of 6.43.
It appears that guinea-pig skin pH most closely
resembles human skin pH, with an average of 5.5.25
Average cutaneous pH levels for other laboratory
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J.L. Matousek and K.L. Campbell

animals include 6.48 in rats, and 6.71 in rabbits.25 The

cutaneous pH of monkeys was similar to that of rats,
with an average pH of 6.42.25
Skin pH in horses ranges from 5.45 to 7.13 and, similar
to cattle and dogs, increases with excitement and
physical stress.6,30,43 Cutaneous pH in pigs ranges
from 5.30 to 7.20.43 Meyer et al.43 reported a cutaneous
pH range of 4.856.06 in goats (German Improved
White, South African Nubian, mix breeds). This is
slightly different from longhaired Angora goats, which
ranged from 5.35 to 7.00.48 In sheep, skin pH is slightly
acidic to alkaline, ranging from 6.14 to 10.00.43,48 The
fleece was not shorn prior to these measurements,
which may have influenced the results. The pH measurements reportedly varied greatly among small subsections of the fleece, both horizontally and vertically.48
Meyer et al.43 proposed that the alkalinity was related
to the presence of lanolin (apocrine and sebaceous
secretions).

FUNCTIONS OF CUTANEOUS PH
As stated previously, the role cutaneous pH plays in the
epidermal barrier has not been fully defined. Functions
of the epidermis can be accomplished through several
different mechanisms. For example, protection from
invasion by micro-organisms is controlled by microbial
desiccation, competition with resident microbiota, and
an acidic pH. It can be difficult to evaluate these effects
independent of one another.
Antimicrobial
Since the realization that the surface of human skin
was acidic, investigators have theorized that this acidity served to protect the skin from bacterial and yeast
infections.6,7 In general, higher bacterial counts are
retrieved from skin with alkaline pH levels.49 In addition, when gram-negative bacteria are placed onto
alkaline skin, they disappear more slowly than they do
on acidic skin.49 Although this may not be the primary
defence mechanism against cutaneous pathogens, the
relatively alkaline pH of canine skin may contribute
to the increased frequency of skin infections in dogs
relative to people and other animal species.50 There are
other possible reasons for the increased incidence of
staphylococcal pyoderma in the dog. Compared with
other species, electron microscopy of the canine
epidermis reveals a relatively thin and compact stratum
corneum, less intercellular lipid, and the lack of a protective lipid plug around the hair follicle infundibulum.51,52 Second, dogs may have a higher level of
cutaneous carriage of bacteria than other species, such
as cats, who have a low occurrence of skin infections.
Krogh and Kristensen53 found that 50% of skin swabs
from 10 normal cats were sterile compared with 20% in
dogs.53 Lastly, because Staphylococcus intermedius is
not a highly virulent organism, disruption of the host
immune defences and immune response are considered
important determinants as to whether infection will
2002 Blackwell Science Ltd, Veterinary Dermatology, 13, 293 300

occur in a particular animal.54 Disorders that predispose dogs to bacterial pyoderma are numerous, and
include hypersensitivity disorders, poor grooming habits,
immune suppression and endocrinopathies.
In vitro and in vivo studies have proven that cutaneous pH can affect the growth of skin microbiota. In
general, a pH of less than 4.0 or 5.0 prevents microbial
growth.24 Although most cutaneous biota can survive
at all of the pH levels found on the skin, small changes
may create an advantage or disadvantage for particular
organisms. An example of this was demonstrated by
Korting et al.55 when they cultured Staphylococcus
epidermidis, Staphylococcus aureus and Propionibacterium
acnes at pH levels ranging from 5.5 to 8.5 (0.5 pH
increments) in vitro. They found that neither of the
staphylococcal species exhibited a difference in growth
rate between pH values of 5.57.0. In contrast, P. acnes
did not grow at a pH of 5.5, and exhibited optimal
growth at pH levels of 6.07.0. Thus, small shifts within
the acidic range, would be expected to affect the growth
of P. acnes more than that of Staphylococci. These
results were supported by several in vivo studies.2,56,57
In one study, the patients washed their forehead and
forearm with synthetic detergents of either pH 5.5 or
8.5.2 Both detergents were identical, except NaOH was
added to adjust the pH. There was a significant correlation between the skin pH and the pH of the product
(the skin was more alkaline with the pH 8.5 synthetic
detergent). Additionally, cutaneous counts of Propionibacterium sp. were significantly higher when the
alkaline cleanser was used. Although the numbers of
cutaneous Staphylococcus sp. increased slightly with
the alkaline preparation, the amount was not significant. A similar study, evaluating products with pH
values of 5.5 and 7.0 yielded similar conclusions.56
These investigations were interesting for several reasons. First, they demonstrated that cutaneous pH plays
a role in controlling bacterial populations on the skin
surface. The extent of the effect of cutaneous pH on the
skin microbiota of other mammals has yet to be determined. It is possible that in mammals with alkaline
skin pH levels (e.g. dogs), the pH may not play as much
of a role in controlling cutaneous bacteria and yeast
populations as it does in those with acidic skin (e.g.
humans). Second, they showed that the growth of
various species of micro-organisms is affected differently
by alterations of pH. In humans, whose normal skin
pH ranges from 3.0 to 6.5, the carriage of staphylococal species was not significantly altered by pH changes
of 5.57.0. It is possible that more extreme changes
in cutaneous pH are needed to alter the carriage of
staphylococcal species. The cutaneous pH of dogs is
higher (4.849.95) than that of people, so the cutaneous pH of dogs would probably need to be decreased
significantly to affect the growth of S. intermedius.
Third, they proved that topical products could change
both the pH and the microbiota of the skin. Unfortunately, similar studies have not been performed in dogs.
In a study evaluating the effects of four acidifying
sprays (pH 2.23.0), vinegar (pH 2.7) and water

Cutaneous pH
(pH 5.7) on canine cutaneous pH, the acidifying sprays
led to a decrease in skin pH from a mean of 7.55 (range
6.39.0) to < 6.0 for a mean duration of 5065 h, while
the vinegar did so for 12 h.46 This study demonstrated
that canine skin pH can be decreased with the use of
acidifying topical products, but did not evaluate the
effect that this may have on cutaneous microbiota.
More investigations are needed to determine if changes
in canine skin pH will lead to alterations in cutaneous
carriage of bacteria and yeast. Concern has been
expressed that the low pH of topical acidifying products may cause cutaneous irritation. Although many
shampoos and conditioners for people are manufactured
to be pH-balanced, studies evaluating the irritancy of
acidifying topical products are conflicting. For the
most part, investigators have shown that the ingredients
of the topical product are more likely to be the cause of
irritation than the pH of the product.5862
In addition to affecting the multiplication of microbes,
cutaneous pH may also alter the virulence of an organism or the susceptibility of the host. An example of this
was demonstrated by Runeman et al.63 when they
experimentally induced Candidal dermatitis under
different pH conditions. They applied Candida albicans
to occlusive patches with pH buffers of 6.0 or 4.5, and
attached these patches onto the forearms of 15 women.
Twenty-four hours after occlusion, the appearance of
skin lesions was significantly (P < 0.0001) more severe
at the control site (pH 6.0) than at the acidic site
(pH 4.5). Despite differences in the visual assessment
of cutaneous lesions, cultures acquired with a scrub
technique showed no significant difference (P = 0.64)
in the amount (cfu/cm2) of C. albicans among the lesions.
One explanation for these findings is that alkaline pH
levels favour the mycelial form of C. albicans, which is
more pathogenic than the yeast form. The authors
concluded that although a relatively alkaline skin pH
does not affect overall cutaneous carriage of yeast, it
does predispose the skin to infection by C. albicans.
Maintenance of normal cutaneous microbiota
The species density of cutaneous microbiota differs at
various anatomic locations. The pH of the skin may
play a role in selecting the resident bacteria and yeast
populations. In vitro, Brevibacterium epidermidis grew
rapidly at pH levels of 5.58.5, but no growth occurred
at a pH of 5.0.1 This organism is primarily located in
the axillae of people, where the cutaneous pH tends to
be neutral to alkaline. Although other factors (skin
temperature, humidity, glandular production) likely
contribute to the maintenance of bacterial and yeast
populations, pH probably has a role.
Keratinization and desquamation
The processes of keratinization and desquamation are
complex, involving changes in keratins, lipids and
enzyme functions. In the past 20 years, investigators
have established that the pH gradient found between
the upper granular layer and the stratum corneum is not
just an innocent bystander. This gradient is thought to

297

have an important role in controlling enzymes that

function in lipid processing and corneocyte adhesion.
Various enzymes (lipases, proteases, phosphatases,
glycosidases) present in keratinocytes and lamellar
granules, are released into the extracellular space during
cornification.8,9 Some of these enzymes exhibit optimal activity in an acidic pH. One example is an enzyme
that esterifies cholesterol in the epidermis (acyl CoA/
cholesterol acetyltransferase). The activity of this enzyme
is increased 10-fold when the pH is decreased from
7.0 to 5.0.9
Mauro et al.8 compared the effects of an acidic (5.5)
and a neutral (7.4) extracellular environment on the
barrier recovery of mouse skin in vitro. First, they
noted that the barrier recovery of skin exposed to an
acidic extracellular pH was significantly faster than in
the skin exposed to a neutral pH. Second, they determined that the delayed barrier restoration was not due
to changes in extracellular ions (Ca2+, K+), or to the
inhibition of lamellar body content extrusion. Third,
they found that skin exposed to the neutral pH had
abnormal arrangements of extracellular lamellar-body
structures, which were not processed into uniform
sheets.8 Mauro et al. then used human skin to demonstrate that the activity of -glucocerebrosidase (an
acid-dependent epidermal enzyme responsible for
extracellular processing of lipids) was decreased by 10
times in a pH of 7.4 compared with a pH of 5.5.
Osborne et al.64,65 also demonstrated that pH was key
in the formation of the lamellar lipid membrane. These
findings illustrate the importance of the pH gradient
established at the junction of the stratum granulosum
and stratum corneum.
Ohman et al.9 further demonstrated that pH is
important in the development of the human cutaneous
barrier when they evaluated the skin as it was healing
after tape stripping. Tape stripping removes the stratum
corneum, which impairs barrier function (reflected by an
increase in TEWL) and results in an alkaline pH.9,66
They found that surface pH decreased rapidly during
the first few days after tape stripping, and normalized
during the second week. A decrease in TEWL paralleled
the decrease in pH, indicating that a normal pH gradient
is important in barrier restoration.9
These pH-dependent processes have primarily been
evaluated in human skin, where the surface is generally
acidic. Because differences in cutaneous pH exist between
species, the results found in people may not pertain to
other animals. For instance, vitamin A-esterifying
enzyme (acyl coA/retinol acetyltransferase) has a pH
optimum of 5.6 in people, but a neutral optimum in
rodents.9 Therefore, it is possible that canine epidermal
enzyme systems require different pH levels for activation
than those identified in people.

DISEASED SKIN
The importance of pH is also demonstrated in disease
states. Some diseases are associated with an increase in
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J.L. Matousek and K.L. Campbell

skin pH (atopic and seborrheic dermatitis), and some

are exacerbated by increases in skin pH (contact
dermatitis, diaper dermatitis, acne vulgaris). In many of
these diseases the pathogenesis of alkalinization is not
clear, but the higher pH likely predisposes the skin to
secondary infections.24
Different stages of eczema are associated with a
range of pH levels. Acute lesions that are erythematous
with exudate and crusts tend to be alkaline, whereas
chronic lesions with lichenification and scale are only
slightly more alkaline than normal skin. One eczema
patient was treated with an acidic potassium acetate
ointment (pH 4.1), and the lesions improved.7 Whether
the alkalinity of the lesions was part of the pathogenesis of the eczema lesions is unclear, but it appeared to
have an exacerbating effect. Sharlit et al.11 proposed that
the keratin on the surface of the skin is at an isoelectric
point, which correlates with the point at which a protein demonstrates the least solubility and swelling, and
the optimum agglutination and precipitation. Goodman6
proposed that as the skin pH becomes more alkaline,
the coagulation of proteins in the stratum corneum
results in decreased stability and decreased resistance
to infection.
Ohman et al. demonstrated a complex interaction
between pH and the pathogenesis of ichthyosis. Cutaneous lesions of X-linked recessive ichthyosis (XRI)
and ichthyosis vulgaris (IV) are similar (hyperkeratosis,
increased scaliness), but the pathogenesis of these
diseases is different. Patients with XRI have a deficiency
in steroid sulfatase, which results in the accumulation
of cholesterol sulfate in the stratum corneum. Cholesterol sulfate is a potent inhibitor of some proteases,
and is proposed to lead to delayed desmosomal cleavage
and retention of corneocytes in the stratum corneum.
Patients with IV have decreased to absent keratohyalin
granules, resulting in low amounts of profilaggrin
(normally converted to filaggrin by proteolysis). Filaggrin
promotes the organization and aggregation of keratin
intermediate filaments, and its breakdown products
(urocanic acid, pyrrolindone carboxylic acid) are
important for retaining moisture in the stratum corneum.13,67,68 Ohman et al. proposed that the cutaneous pH of lesions in these patients was a reflection of
an altered concentration of the normal molecules
produced during keratinization.13 They evaluated the
cutaneous pH, and the pH gradient through the stratum
corneum by tape stripping. In their study the mean
skin surface pH of XRI patients (4.5) was similar to
controls (4.6), but the surface pH of IV patients was
slightly higher (5.3). As may be expected, more tape
strippings were necessary in patients with ichthyosis
than in the normal controls. In XRI patients, the pH
gradient was shallower than normal, and plateaued at
a pH of 6.0 (instead of 7.0 in normals). They proposed
that this acidic end point was due to excessive amounts
of cholesterol sulfate (an acidic lipid) in the lower stratum corneum. The patients with IV attained a neutral
pH faster than the normal patients. They proposed
that the lack of urocanic and pyrrolidone carboxylic
2002 Blackwell Science Ltd, Veterinary Dermatology, 13, 293 300

acid in the stratum corneum led to a more neutral to

alkaline pH on the skin surface and throughout the
stratum corneum. This fairly neutral pH gradient may
affect the activity of pH-dependent enzymes that aid
in corneocyte desquamation, further aggravating the
lesions of ichthyosis.13 The neutral to alkaline pH and
the abnormal retention of corneocytes probably
predispose the skin to secondary infection.

CONCLUSION
In conclusion, it is clear that cutaneous pH values
differ among animals and people. Although debate still
exists over the significance of cutaneous pH, there is
evidence for its roles in the normal keratinization
process and barrier functions of the skin. In addition,
alterations in cutaneous pH may occur as a result of a
cutaneous disorder, or may predispose the skin to disease. Future studies should help further define the role
of cutaneous pH in animals and people.

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Rsum Cet article dcrit le rle du pH dans les structures et les fonctions cutanes. Les molcules contribuant
lacidit ou lalcalinit cutane sont dabord dcrites. Puis les diffrences de pH cutan en fonction des espces,
des individus et pour chaque individu sont rapportes. Les fonctions possibles du pH cutan sont analyses
pour la peau normale et pour les dermatoses. Par exemple, le pH cutan prsente un rle de slection et de
maintenance de la flore cutane normale. En outr, lacidit cutane pourrait protger la peau contre les
infections par des microbes. Enfin, un gradient de pH cutan active des enzymes dpendant du pH, impliques
dans le processus de keratinisation.
Resumen Esta revisin describe el papel del pH en la estructura y funcin cutnea. Primero se describen las
molculas que contribuyen a la acidez o alcalinidad de la piel. Despus, se describen las diferencias en el pH
cutneo entre especies, entre individuos de la misma especie y entre individuos. Se analizan las funciones
potenciales del pH cutneo en piel normal y enferma. Por ejemplo, el pH cutneo tiene un papel en la seleccin
y mantenimiento de la flora cutnea normal. Adems, la acidez cutnea puede proteger la piel contra infecciones
microbianas. Finalmente, est probado que un gradiente del pH cutneo activa los enzimas pH-dependientes
implicados en el proceso de queratinizacin.
Zusammenfassung Diese bersicht beschreibt die Rolle des kutanen pH fr die Struktur und Funktion der
Haut. Zuerst werden die Molekle beschrieben, die zum Suregrad oder zur Alkalitt der Haut beitragen. Dann
werden Unterschiede im kutanen pH zwischen Spezies, zwischen Individuen derselben Spezies und innerhalb
einzelner Individuen beschrieben. Die mglichen Funktionen des kutanen pH in normaler und erkrankter Haut
werden analysiert. Zum Beispiel spielt der kutane pH eine Rolle in der Auswahl und Erhaltung der normalen
kutanen Mikroflora. Zustzlich schtzt der kutane Suregrad die Haut mglicherweise gegen mikrobielle
Infektionen. Und schliesslich gibt es Hinweise darauf, dass der kutane pH Gradient am Keratinisierungsprozess
beteiligte pH-abhngige Enzyme aktiviert.
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