Bathing Recommendations for Atopic Eczema
Daily bathing or showering is not necessary for individuals with atopic eczema; alternate day bathing is appropriate and may be beneficial for some patients. 1
Optimal Bathing Frequency
- Showering/bathing daily or less frequently is associated with lower atopic dermatitis severity compared to more than daily bathing 1
- No significant differences in eczema severity have been found between daily bathing and less frequent bathing (less than daily) 1, 2
- Daily bathing does not worsen atopic dermatitis severity compared to less frequent bathing 2
- Bathing is useful for most patients for both cleansing and hydrating the skin 3
Proper Bathing Technique
- Bathe in warm water (not hot) for at least 10 minutes 3, 4
- Use neutral pH, fragrance-free hypoallergenic soaps or non-soap cleansers instead of regular soaps that remove natural lipids from the skin 3
- A dispersible cream should be used as a soap substitute to cleanse the skin 3
- Apply moisturizers immediately after bathing to lock in hydration and prevent transepidermal water loss 3, 1
Bathing Additives
- The Joint Task Force Practice Parameter supports the use of bathing additives like oatmeal for symptomatic relief of pruritus and skin irritation 4
- The American Academy of Dermatology recommends against the use of bath additives, with the exception of bleach baths 3, 4
- Patients should be allowed to decide on the most suitable bath oil and bathing regimen for their individual needs 3
Post-Bath Care
- Consistent application of moisturizer after showering/bathing is associated with lower objective SCORAD, EASI, and POEM scores (measures of eczema severity) 1
- Even inconsistent application of moisturizer after bathing shows benefits compared to no moisturizer application 1
- Emollients provide a surface lipid film which retards evaporative water loss from the epidermis 3
Important Considerations
- Showering/bathing duration was not associated with atopic dermatitis outcomes, suggesting that recommendations concerning shower durations may not be necessary 1
- Only about 29% of atopic dermatitis patients report being favorable to baths, highlighting the importance of patient preference in bathing recommendations 5
- Patients with severe atopic dermatitis may have less adherence to showering/bathing recommendations 1
- Daily bathing using weakly acidic syndets (synthetic detergents) can reduce skin symptoms of pediatric atopic dermatitis during the summer season 6
Avoiding Triggers
- Avoid extremes of temperature that can exacerbate eczema 3
- Keep nails short to minimize damage from scratching 3
- Wear cotton clothing rather than wool or synthetic fabrics that may irritate the skin 3
The most recent and highest quality evidence suggests that bathing daily or less frequently is appropriate for atopic eczema management, with the critical factor being proper moisturization after bathing rather than the frequency itself 1. Patient preference should be considered, as adherence to a consistent bathing routine with proper post-bath moisturization appears more important than the specific frequency.