Eczema (atopic dermatitis) is a common inflammatory skin condition characterized by dry, intensely itchy skin and recurrent rashes. Many individuals explore traditional home remedies like Apple Cider Vinegar (ACV) for potential relief. However, applying this acidic substance to compromised skin carries a significant risk of irritation and worsening the condition. This article explores why ACV may be counterproductive to skin health.
Understanding Eczema and the Skin Barrier
Eczema skin possesses a defective barrier function. This compromise allows moisture to escape, leading to dryness and increased transepidermal water loss (TEWL). The broken barrier also makes the skin highly susceptible to penetration by external irritants, allergens, and microbes.
Healthy skin maintains an “acid mantle,” a protective film with a mildly acidic pH (4.5 to 5.5). Eczema skin often exhibits an elevated, more alkaline pH level. This shift impairs enzyme activity necessary for maintaining skin integrity, further weakening the barrier. The alkaline environment encourages the overgrowth of harmful bacteria, such as Staphylococcus aureus.
The Theoretical Appeal of Apple Cider Vinegar
The appeal of ACV stems from the altered skin pH found in eczema. Because ACV is naturally acidic due to its acetic acid content, proponents theorize that topical application could help re-acidify the skin’s surface. This theoretical restoration of the acid mantle is believed to normalize enzyme function, potentially improving barrier repair and reducing inflammation.
A secondary benefit is the mild antimicrobial property of acetic acid. Since eczematous skin is prone to colonization by Staphylococcus aureus, the hope is that ACV could help reduce this bacterial load. This proposed cleansing effect, combined with the pH-balancing idea, has led to ACV being widely shared as a home remedy for managing flare-ups.
Why ACV May Worsen Eczema Symptoms
Despite theoretical benefits, direct ACV application poses substantial risks to damaged skin. Undiluted ACV is a strong acid, and even when improperly diluted, it causes immediate and intense irritation. The acetic acid triggers a painful stinging or burning sensation, especially on cracked or inflamed skin.
The danger extends beyond irritation; documented cases show ACV causing contact dermatitis and chemical burns. Applied under occlusion, such as a bandage, the acid concentrates against the skin, leading to tissue damage. This is concerning for individuals following protocols advocating for frequent, undiluted use.
For inflamed skin, the physical irritation caused by ACV provokes the inflammatory cascade. This exacerbation leads to increased redness, swelling, and itching, worsening eczema severity. Clinical evidence supporting ACV’s efficacy is limited, while the risks of adverse skin reactions are observed in case reports.
Guidelines for Safe Use and Dermatologist Recommended Alternatives
Anyone considering using ACV should proceed with extreme caution due to the risk of chemical irritation. If attempting an ACV bath, add only a small amount (such as a cup) to a full tub of water to ensure heavy dilution. Always perform a patch test on a small, unaffected area of skin 24 hours prior to wider application.
The safest approach is to rely on treatments supported by clinical evidence. Dermatologists recommend gentle, fragrance-free emollients, such as thick ointments or creams rich in ceramides and lipids, to repair the skin barrier. Other effective bathing treatments include colloidal oatmeal baths to soothe itching or mild bleach baths to reduce bacterial colonization. For active flare-ups, prescription treatments like topical steroids or calcineurin inhibitors are often necessary to reduce inflammation.