Dear Editor,

I would like to bring to your notice an unusual question. If excess of anything is abnormal, does this mean an excess of cleanliness can lead to harmful effects? It is a general notion that one has to be clean in order to remain healthy and that poor hygiene leads to diseases and ill health. This is universally accepted and is true in most circumstances. However an excess of anything can be considered abnormal. Similarly undue importance to cleanliness can deprive an individual from the protective properties associated with it. It is the balance between cleanliness and untidiness that requires to be understood in order to derive benefits from both.

There is adequate evidence to support many conditions that adversely disrupt quality of life and cause serious illnesses that may be attributed to being excessively clean and tidy. In the field of Otorhinolaryngology (ENT), patients in the Indian set up have often presented with severe excruciating pain and discomfort in either of their ears due to entry of insects such as cockroaches and house wasps. These have been seen exclusively in individuals who spend a lot of time cleaning out the wax from their ears. This therefore also predisposes to impaction of wax causing conductive deafness if pushed deep within the canal and if at all is removed completely makes an individual vulnerable to insect entry as cerumin (wax) possesses insect repelling and protective properties (antibacterial/antifungal) especially in those who sleep on the floors and have underlying chronic diseases such as Diabetes. Moreover, repeated attempts to remove ear wax (when not causing ear blockage) can cause injury to the external auditory canal and stimulate the vagal innervations in the canal wall often leading to cardiac depression and syncope [1,2].

In another instances, the recently established hygiene hypotheses in nasal allergy proves the association between cleanliness and increased risk of developing allergy in children, which has a lifelong morbidity [3]. This hypotheses states that exposure to allergens in the environment early in life reduces the risk of developing allergies by boosting immune system activity. Conversely, relatively clean environment in early life would sway the immune system towards allergy-promoting responses [4].

In routine psychiatric practice, patients who have abnormal concerns with cleanliness over a long period of time are categorized into a spectrum of Obsessive Compulsive Disorders (OCD) with predominant cleaning compulsions. This leads to lots of anxiety if such cleaning compulsions are not performed, which invariably affects overall performance and mental distress to the patient. Other conditions that are physically painful and disabling like the housemaid’s knee (pre patellar bursitis) and early osteoarthritis develop at an early age in Indian housewives due to daily chores involving physically straining cleaning activities. Variations in head positions and frequent neck body and body movements during cleaning of household items and surroundings over a long period of time can also lead to postural hypotension, cervical spondylosis and vertigo which only adds to the patients worsening life style.

Hence, it could be concluded that even though cleanliness is important for good health, we must not fail to warn the harmful effects due to its excess. A suitable balance between cleanliness and untidiness should be emphasized in order to maintain optimum health such that an excess of one does not compromise overall quality of life and well being.