A critical part of treating and preventing relapses of atopic dermatitis (eczema) is good routine skin care. Bathing is an important step in skin care, as it hydrates the skin and removes scale, crust, irritants, and allergens. Adequate hydration of the skin is required to help preserve the skin’s natural barrier and minimize the effects from irritants or allergens, which can worsen atopic dermatitis.1,2
The American Academy of Dermatology recommends that people bathe both to treat active flare-ups and maintain healthy skin and prevent recurrences of eczema. It is generally recommended that bathing, or showering, is done once daily. Bathing may be slightly better than showering to soak inflamed skin. Baths and showers should be kept short (less than 10-20 minutes).
Moisturizing after bathing
Immediately following bathing, moisturizers should be applied to the damp skin to seal in moisture and help repair the skin barrier. If the water from bathing is left to evaporate on the skin, it increases the amount of water lost through the skin, which is already out of balance with atopic dermatitis. Applying moisturizers immediately after bathing and gently patting the skin dry with a towel helps maintain good hydration in the skin. Moisturizers also help lessen the symptoms, including itch, redness, cracks in the skin, and thickening of the skin (lichenification).1
Water temperature
Hot water can trigger flare-ups, particularly worsening itch and dry skin, and should be avoided. The optimal water temperature for people with AD is lukewarm water.1
Soaps and cleansers for atopic dermatitis
People with atopic dermatitis should use non-soap cleansers or soaps that are hypoallergenic, fragrance-free, and have a neutral to low pH (less than 5.5). Many soaps are alkaline in pH, and the skin’s normal pH is slightly acidic. Alkaline soaps can cause damage to the skin’s surface, increase dry skin, and cause irritation. Non-soap cleansers are often better tolerated by people with eczema.1
Examples of soaps that are mild and fragrance free with a neutral pH include Dove, Oil of Olay, Caress, Camay, Aveeno, and Purpose. However, even these mild soaps may be too drying for some people with eczema, who may prefer bathing in water alone. Baby shampoo can be helpful to manage eczema on the scalp.2
Bleach baths
For people with moderate to severe atopic dermatitis who have repeated skin infections, the addition of bleach to the bath a few times a week can be helpful to decrease the amount of bacteria on the skin’s surface and reduce the chance of infections. Bleach baths involve adding 2 teaspoons of bleach per gallon of water. (A typical bathtub holds between 25-40 gallons of water.) For a full bathtub, use ½ cup of bleach. For a half full tub, use ¼ cup of bleach. Regular strength bleach (6%) should be used – not concentrated bleach. Clinical studies have proven that bleach baths can reduce the bacteria found on the surface of the skin and reduce infections.1,3
Pat the skin dry
After bathing is complete, the skin should be gently patted dry with a towel. Leaving some dampness on the skin is preferable. Moisturizers should then be applied to the skin to retain the skin’s moisture.1,2
