Should I avoid hot showers, especially if I have sensitive skin or conditions like multiple sclerosis (MS) or Raynaud's disease?

Should You Avoid Hot Showers?

For most healthy individuals, hot showers are safe, but you should avoid them if you have sensitive skin conditions (like EGFR-inhibitor-induced skin reactions), and exercise extreme caution if you have multiple sclerosis due to risk of neurological deterioration.

For Patients with Sensitive Skin or Dermatologic Conditions

Avoid hot showers if you have xerotic (dry) or eczematous skin, as hot water causes dehydration and worsens skin barrier function. 1

• Hot showers strip natural oils and moisture from the skin, exacerbating dryness, eczema, and fissures 1
• This is particularly critical for patients on EGFR-inhibitor cancer therapy, where hot showers are explicitly listed as treatments to avoid 1
• Instead, use lukewarm water and immediately apply emollients after bathing to restore moisture 1

For Patients with Multiple Sclerosis

Completely avoid hot showers and hot baths if you have MS, as heat exposure can precipitate persistent and severe neurological deficits. 2

• Hot bath testing in MS has caused considerable and prolonged neurological debilitation in documented cases 2
• While historically used as a diagnostic test, the risk of persistent neurological deficit makes hot water exposure dangerous 2
• The mechanism involves heat-induced conduction block in demyelinated nerves, which may not fully resolve 2

For Patients with Raynaud's Phenomenon

Hot showers are NOT contraindicated for Raynaud's phenomenon; in fact, hand warming with hot water is therapeutic. 3

• Warming hands in hot water for 5 minutes every 4 hours significantly decreases the number and duration of Raynaud's attacks in systemic sclerosis patients 3
• This intervention increases blood flow as measured by laser-Doppler flowmetry 3
• The key recommendation is thorough drying of skin after moisture exposure to prevent cold-induced vasospasm 4
• Avoid direct contact with cold surfaces and use gloves/heating devices for hands 4

For Patients at Risk of Mycobacterial Infection

Consider avoiding showers if you have bronchiectasis or previous mycobacterial lung disease, as indoor showerheads are a known source of nontuberculous mycobacteria (NTM), especially MAC. 1

• Indoor showerheads harbor NTM that can be aerosolized during showering 1
• This is particularly relevant for susceptible hosts with bronchiectasis or cystic fibrosis 1
• However, expert consensus has not been reached on whether environmental shielding (avoiding showers) is necessary for all at-risk patients 1
• If you have documented MAC hypersensitivity-like disease from hot tub exposure, completely avoid indoor hot tubs 1

General Safety Considerations

Hot water temperature should be regulated to prevent burn injuries, particularly for elderly patients and those with psychomotor disorders. 5

• Adults over 60 with psychomotor disorders are at highest risk for hot water burns, with 44% mortality in one series 5
• Burns from hot bath and shower water tend to be more extensive and deeper in adults compared to children 5
• Water temperature regulation is essential for vulnerable populations 5

Practical Algorithm for Decision-Making

1. If you have MS: Avoid hot showers entirely 2
2. If you have dry/sensitive skin or are on EGFR-inhibitor therapy: Use lukewarm water only and apply emollients immediately after 1
3. If you have Raynaud's phenomenon: Hot water is beneficial for hands, but ensure thorough drying afterward 4, 3
4. If you have bronchiectasis or previous NTM infection: Discuss with your pulmonologist whether shower avoidance is warranted 1
5. If you are elderly or have impaired mobility/sensation: Ensure water temperature is regulated to prevent burns 5