Eczema, or atopic dermatitis, is a chronic inflammatory condition characterized by intense itching, dryness, and inflamed skin. This occurs because of a compromised skin barrier, which struggles to retain moisture and keep out environmental irritants. Many people avoid bathing, believing water dries out the skin, but this approach can worsen symptoms. When performed using a specific technique, bathing is a powerful tool for rehydrating the skin and managing flare-ups.
The Role of Water in Skin Barrier Health
The skin’s outermost layer acts like a protective wall. In eczema, this wall is structurally damaged, allowing moisture to escape rapidly—a process known as Transepidermal Water Loss (TEWL). Because the barrier is damaged, the skin quickly dries out after a bath if hydration is not immediately locked in.
The primary function of a therapeutic bath is to actively rehydrate the skin by allowing the compromised barrier to absorb water. Soaking temporarily plumps the skin cells, making moisturizers more effective afterward. Bathing also washes away surface irritants, allergens, and crusts that contribute to inflammation and infection.
Therapeutic Bathing Techniques
The effectiveness of a bath for eczema relief depends on adhering to specific parameters. The water temperature should be lukewarm or tepid, never hot, as high temperatures strip the skin of its protective oils and aggravate inflammation. A recommended temperature range is around 27–30°C.
The soak duration should be kept short, typically between five and ten minutes, to maximize water absorption. A daily bath, or one every other day, is often recommended to maintain consistent hydration and remove irritants. Use only gentle, fragrance-free, and dye-free cleansers, applying them only to soiled areas. Use your hands to gently cleanse the skin, avoiding abrasive tools like washcloths or loofahs, which can cause micro-tears.
Recommended Bath Additives for Eczema Relief
Certain substances can be added to the bathwater to enhance the therapeutic effects, providing soothing or antibacterial benefits. Colloidal oatmeal is a popular additive, consisting of finely ground whole oat kernels that dissolve to create a milky, soothing bath. The avenanthramides in oatmeal have anti-inflammatory and antioxidant properties that help reduce itching and irritation.
Bath oils are also used to moisturize the skin during the soak by forming a thin protective layer. Use only fragrance-free oils formulated without harsh chemicals, as perfumes and dyes can irritate sensitive skin. For frequent infections or bacterial colonization, a diluted bleach bath may be recommended by a healthcare provider.
A bleach bath uses a very small amount of household bleach (typically half a cup of 5%–6% sodium hypochlorite for a 40-gallon tub) to reduce Staphylococcus aureus bacteria. This bath is done for five to ten minutes and must be followed by a rinse with plain water. Bleach baths should only be used after consulting with a medical professional for precise dosing and frequency instructions.
The Critical “Soak and Seal” Method
The “Soak and Seal” method is the most important step in managing eczema through bathing, and it must immediately follow the bath. Without sealing, the absorbed water quickly evaporates, leading to increased Transepidermal Water Loss (TEWL) and potentially drier skin. The entire sealing process must begin within three minutes of exiting the water, often called the “three-minute rule.”
Upon leaving the bath, gently pat the skin with a soft, clean towel, leaving it slightly damp. The skin must retain surface moisture to be sealed in by the emollient. Prescribed topical medications, such as steroid creams or calcineurin inhibitors, are then applied directly to affected patches as directed by a doctor.
The final step involves liberally applying a thick layer of a fragrance-free moisturizer, such as a cream or an ointment, over the entire body. This occlusive layer creates a physical barrier on the skin’s surface, preventing the newly absorbed water from evaporating and significantly reducing TEWL. This rapid, two-part process transforms the bath into a powerful therapeutic treatment for eczema.