Bathing Recommendations for Atopic Eczema
For individuals with atopic eczema, daily bathing or showering is recommended over alternate-day bathing, and either baths or showers can be effective as long as proper techniques are followed and moisturizers are applied immediately afterward. 1, 2
Optimal Bathing Frequency
- Daily bathing or showering is associated with lower atopic dermatitis severity compared to more frequent bathing (more than once daily), which can worsen symptoms 1
- Bathing less than daily (alternate days) has not shown significant benefits over daily bathing in managing atopic dermatitis 1
- Daily bathing using weakly acidic cleansers has been shown to reduce skin symptoms in pediatric atopic dermatitis, especially during summer months 2
Bath vs. Shower: Which is Better?
- Both baths and showers can be effective for atopic dermatitis management, with no strong evidence favoring one over the other 3
- The choice between bath or shower should be based on patient preference, as guidelines recommend allowing patients to decide on the most suitable bathing regimen 3
- Bathing is useful for both cleansing and hydrating the skin in most patients with atopic eczema 4
Proper Bathing Technique
- Use warm water (not hot) for bathing or showering to avoid triggering flares 3
- Avoid regular soaps and detergents which remove natural lipids from the skin surface 4
- Use a dispersible cream as a soap substitute to cleanse the skin 4
- Limit bathing duration to approximately 10 minutes (though research shows duration may be less important than frequency and post-bath care) 3, 1
Post-Bath Care: Critical for Success
- Apply moisturizers immediately after bathing to lock in hydration - this is the most important step 3, 1
- Emollients provide a surface lipid film which retards evaporative water loss from the epidermis 4
- Consistent application of moisturizer after bathing/showering is associated with lower atopic dermatitis severity scores 1
Additional Considerations
- Bath additives like oatmeal may provide symptomatic relief for some patients, though evidence is mixed 5
- The American Academy of Dermatology recommends against most bath additives, with the exception of bleach baths for infection control 5, 6
- Avoid extremes of temperature, keep nails short, and wear cotton clothing rather than wool or synthetic fabrics that may irritate the skin 4
Common Pitfalls to Avoid
- Skipping moisturizer application after bathing can negate the benefits and lead to increased dryness 1
- Using water that is too hot can trigger flares and worsen symptoms 3
- Using regular soaps instead of gentle, non-soap cleansers can strip natural oils and worsen skin barrier function 4, 3
- Bathing more than once daily is associated with higher atopic dermatitis severity scores and should be avoided 1