Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition that affects millions of people. The underlying issue is a compromised skin barrier, the outermost layer of skin that normally acts like a protective wall. Because this barrier is weakened, the skin loses moisture rapidly, a process called transepidermal water loss, while simultaneously allowing irritants and allergens to penetrate the skin. This cycle of dehydration and irritation causes the characteristic dryness, itching, and inflammation associated with a flare-up. The goal of bathing is to safely reintroduce moisture and remove surface irritants without causing further damage to the fragile barrier.
Determining Optimal Bathing Frequency
The question of how often to shower with eczema has long been debated. Previous guidelines often recommended daily bathing to hydrate the skin. This practice is beneficial because it rehydrates the outermost layer of the skin, which is often severely dry in eczema sufferers. However, recent research suggests that the frequency may be less important than the technique used during and after the wash. A short, frequent shower or bath is acceptable because it removes the buildup of environmental irritants, allergens, and bacteria that can accumulate and trigger a flare.
For many, bathing daily is a practical and effective way to manage symptoms, provided the entire process takes less than 15 minutes. Infrequent bathing can allow sweat, dirt, and dead skin cells to collect on the skin’s surface, increasing irritation and the risk of infection. The choice between daily and less frequent bathing should be guided by personal tolerance and the specific reaction of one’s own skin, as long as the crucial post-bathing steps are consistently followed. Avoiding long, hot soaks is recommended, as they strip the skin of natural protective oils more quickly than a short, warm wash.
Essential Techniques While Washing
Temperature and Duration
The temperature and duration of the shower are two of the most controllable factors that influence the skin barrier. Water should be lukewarm, not hot, as excessively warm water increases blood flow to the skin and can intensify the feeling of itchiness. Showers should be kept brief, ideally between five and ten minutes, to maximize hydration without causing the skin to lose its natural moisture. Prolonged exposure to water can actually dry the skin out further, negating the intended benefit of bathing.
Cleanser Choice and Application
Selecting the correct cleanser is a significant consideration for eczema care. Harsh, traditional bar soaps should be avoided because their high pH level disrupts the skin’s naturally acidic balance, leading to increased dryness and irritation. Instead, use a gentle, fragrance-free, pH-neutral, or soap-free cleanser formulated for sensitive skin. These products clean without stripping the skin of the lipids that help maintain the barrier function.
When applying the cleanser, use your hands to gently pat or smooth the product onto the skin, rather than rubbing vigorously. Washcloths, sponges, or abrasive loofahs should not be used, as the friction they create can cause micro-tears in the delicate skin barrier. Ensure all traces of the cleanser are rinsed away completely before stepping out of the shower to prevent residue from causing irritation.
The Critical Role of Post-Bathing Moisturizing
The moisturizing application that immediately follows bathing is the most important step in an eczema routine. After exiting the shower, resist the urge to rub the skin dry with a towel, which can cause friction and irritation. Instead, gently pat the skin with a soft cotton towel, leaving a thin layer of moisture on the surface. The skin should feel damp, but not dripping wet.
This dampness is the absorbed water that needs to be sealed into the skin barrier to prevent it from evaporating, which is the basis of the “soak and seal” method. The moisturizer must be applied liberally to the entire body within three minutes of leaving the water. Applying the moisturizer to damp skin traps the water molecules, maximizing hydration. Waiting longer than three minutes allows the absorbed water to evaporate, potentially leaving the skin drier than before the shower.
For eczema management, a heavy cream or a thick ointment is recommended over a thin lotion. Lotions contain a high amount of water and less oil, making them less effective at creating a durable protective seal against moisture loss. Creams and ointments, conversely, have a higher oil content, providing a more robust, occlusive layer that effectively locks the water into the skin, supporting the barrier function until the next application.