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We summarized experimental studies evaluating in vitro efficacy of water\u2010only or soap and water in decontaminating chemical warfare agents (CWA) or their simulants from human skin models. Embase, Covidence\u00ae, MEDLINE, PubMed, Web of Science, and Google Scholar were searched for articles using water\u2010only or soap and water decontamination methods for removal of CWA\/CWA simulants in in vitro human skin models. Data extraction was completed from seven studies, yielding seven contaminants. Water\u2010only decontamination led to partial decontamination in all skin samples (100%, <jats:italic>n<\/jats:italic>\u2009=\u200981\/81). Soap and water decontamination led to partial decontamination in all skin samples (100%, <jats:italic>n<\/jats:italic>\u2009=\u2009143\/143). Four studies found decontamination to either paradoxically enhance absorption of contaminants or their penetration rates, known as the \u201cwash\u2010in\u201d effect. Despite recommendations, water\u2010only or water and soap decontamination were found to yield partial decontamination of CWA or their simulants in all human in vitro studies. Thus, more effective decontaminating agents are needed. Some studies demonstrated increased or faster penetration of chemicals following decontamination, which could prove deadly for agents such as VX, although these findings require in vivo validation. Heterogeneity in experimental setups limits interstudy comparison, and it remains unclear when water\u2010only or water and soap are ideal decontaminants, which requires more studies. Pending manuscripts will summarize in vivo human and animal efficacy data. International harmonized efficacy protocol should enable more efficient public health decisions for evidence\u2010based public health decisions.<\/jats:p>","DOI":"10.1002\/jat.4251","type":"journal-article","created":{"date-parts":[[2021,10,21]],"date-time":"2021-10-21T06:23:00Z","timestamp":1634797380000},"page":"930-941","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Efficacy of water\u2010only or soap and water skin decontamination of chemical warfare agents or simulants using in vitro human models: A systematic review"],"prefix":"10.1002","volume":"42","author":[{"given":"Chavy","family":"Chiang","sequence":"first","affiliation":[{"name":"School of Medicine and Dentistry University of Rochester  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Kashetsky","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Memorial University  St. John's Newfoundland &amp; Labrador Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aileen","family":"Feschuk","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Memorial University  St. John's Newfoundland &amp; Labrador Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anuk","family":"Burli","sequence":"additional","affiliation":[{"name":"School of Medicine and Dentistry University of Rochester  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca M.","family":"Law","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Memorial University  St. John's Newfoundland &amp; Labrador Canada"},{"name":"School of Pharmacy Memorial University  St. John's Newfoundland &amp; Labrador Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard I.","family":"Maibach","sequence":"additional","affiliation":[{"name":"Department of Dermatology University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,10,19]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1017\/s1049023x00008529"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0179309"},{"issue":"8","key":"e_1_2_7_4_1","first-page":"228","article-title":"Effects of surfactants in percutaneous absorption","volume":"61","author":"Ashton P.","year":"1986","journal-title":"Pharmaceutica Acta Helvetiae"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/185017a0"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/0960327108090269"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/10937404.2010.483940"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1515\/reveh-2014-0052"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-196501000-00010"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0278-6915(85)90228-5"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0278-6915(90)90111-y"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/10937404.2021.1943087"},{"key":"e_1_2_7_13_1","unstructured":"Centers for Disease Control and Prevention (CDC). 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