Eczema is a chronic inflammatory skin condition characterized by a damaged skin barrier, leading to dryness, itching, and inflammation. Common alcohols, such as rubbing alcohol or hand sanitizers containing ethanol or isopropyl alcohol, should be avoided on inflamed skin. This article explains the scientific reasons behind this recommendation, detailing the negative effects of these alcohols and providing safer alternatives for cleaning and managing flare-ups.
Why Common Alcohols Are Detrimental to Eczema
Common drying alcohols, like ethanol, denatured alcohol, and isopropyl alcohol, are powerful solvents. When applied, these short-chain alcohols rapidly strip away the skin’s natural lipid layer, which provides a protective seal. This lipid dissolution compromises the skin’s defense mechanism against the external environment.
Removing these lipids leads to an immediate sensation of intense stinging and burning on already inflamed or broken skin. The astringent effect causes immediate irritation and redness. Furthermore, the rapid evaporation of these volatile alcohols contributes to significant moisture loss from the skin’s surface.
This stripping action exacerbates existing inflammation, making the skin drier and more irritated. Repeated application can lead to increased sensitivity and prolonged flare-ups, directly undermining the goals of eczema management, which focus on restoring moisture and protecting the skin barrier.
The Role of the Skin Barrier in Eczema Flares
Eczema is fundamentally linked to a defect in the skin barrier, often described using the “bricks and mortar” analogy. The skin cells are the bricks, and the lipids are the mortar holding them together and sealing the barrier.
The solvent action of drying alcohols accelerates transepidermal water loss (TEWL). TEWL measures how much water passively evaporates from the skin’s surface, and alcohols significantly increase this rate by dissolving the lipid mortar. This rapid dehydration cycle leaves the skin feeling tight and brittle.
A compromised barrier that is losing excessive moisture becomes highly susceptible to penetration by allergens, irritants, and environmental pathogens. This allows substances that would normally be blocked to enter the skin, triggering an immune response that leads to a prolonged or worsened flare-up. Any substance that increases TEWL, like common alcohols, directly perpetuates the cycle of eczema.
Navigating Alcohol Ingredients: Drying Versus Fatty Types
The term “alcohol” on an ingredient list can be confusing for consumers, as not all alcohols are detrimental to eczematous skin. It is important to distinguish between the harsh, drying types and the beneficial, non-drying types. Drying alcohols, which must be avoided, include:
- Ethanol
- SD Alcohol
- Alcohol Denat.
- Isopropyl Alcohol
In contrast, many eczema-friendly moisturizers and creams contain ingredients known as fatty alcohols. These are long-chain alcohols derived from natural fats or oils, such as Cetyl Alcohol, Stearyl Alcohol, Cetearyl Alcohol, and Behenyl Alcohol. These ingredients do not behave like solvents.
Fatty alcohols are non-drying and function primarily as emollients, thickeners, or emulsifiers. They help soften and soothe the skin by forming a protective layer on the surface. This layer prevents moisture loss and supports the repair of the damaged skin barrier, making them safe components in formulas designed for sensitive skin.
Safe Cleaning and Disinfecting Alternatives for Eczematous Skin
For routine cleansing, the best approach for eczematous skin is to use gentle, non-soap cleansers, often referred to as synthetic detergents or syndets. These products have a pH closer to that of the skin and are formulated to clean without stripping natural lipids like traditional soaps can. They help maintain the skin’s integrity while removing environmental debris and irritants.
Diluted Bleach Baths
For disinfecting the skin during an active flare, especially when infection is suspected, dermatologists often recommend a diluted bleach bath. This involves adding a small amount of regular household bleach (sodium hypochlorite) to a tub of lukewarm water. The dilution is mild, similar to the chlorine level in a swimming pool, and helps reduce Staphylococcus aureus bacteria, which commonly colonizes eczematous patches.
The recommended protocol is to soak for five to ten minutes, no more than two or three times per week. After soaking, the skin should be rinsed gently with fresh water, then patted dry with a clean towel. Immediately follow this with the “soak and seal” regimen, applying prescribed topical medications and thick moisturizers to the slightly damp skin to lock in moisture.