Bathing Tips for Atopic Dermatitis and Beyond

In our office, we do not see as many patients with atopic dermatitis, because our local pediatricians do an excellent job in managing many patients. However, there are a few dermatologist skincare treatment tips to share in this article.  This is Part 2 of 5

Tips for Bathing

Many dermatologists recommend taking infrequent tepid baths and showers.  I am not one of those dermatologists.  I love nothing more than a long hot shower.  Atopic dermatitis patients may take baths or showers of any temperature AS LONG AS they use a mild soap and moisturize well immediately after bathing.  For bar soap, I often recommend Cetaphil, Cerave, and Vanicream.  For liquid soap, I usually recommend Cetaphil Restoraderm Soothing Wash which can be added to bathwater as well.  There is now a significant amount of data showing that patients with atopic dermatitis have impaired barrier function, so choosing a wash that is designed to improve the skin barrier is helpful.

Bath Water Additives

I generally do not recommend adding much to the bathwater.  Many bath oils contain potential allergens.  Oatmeal baths are very messy. Salts haven’t proven to help much. 

Bleach Baths

Bleach is a common dermatologist recommendation.  When I was training, I spent time going to conferences at the NIH where “bleach baths” were a common prescription for the skin.  The reasoning is that many patients with chronic skin conditions are colonized with bacteria, most commonly Staph aureus, that leads to frequent infection and irritation of their rash.  However, newer science focuses more on protecting the skin biome.  The skin biome is the combination of bacteria, fungus, mites, and yeast that live on all of our skin to some extent and perform a function to maintain homeostasis on the skin.  Similar to trying to protect “good” bacteria in the GI tract, science is backing off on antibacterial agents for the skin.  Plus, the effects of bleach on the lungs of children who already may have breathing difficulties associated with atopic dermatitis is questioned.  My compromise for patients that I truly believe have a bacteria problem worsening their rash is to use Hibiclens (OTC) surgical scrub a few times a week and Mupirocin (RX) ointment on any areas that look infected. 

Soak and Smear

I am getting old.  So, I have some remembrance of old skincare regimens recommended by dermatologists older than me that involved a “soak and smear” technique.  This is an intensive, messy but VERY effective regimen for resistant cases of atopic dermatitis.  It is a short-term, intensive treatment done at least every other night for two weeks.  Affected areas are “soaked” in a warm water bath with no additives.  Then immediately after exiting the soak (without drying and within 3 minutes) the affected area is “smeared” with Triamcinolone 0.1% ointment.  The same ointment is then applied again in the morning without soaking.  As the skin improves, the “smear” can be transitioned to Vaseline.  Having kids makes me hesitant to recommend this full regimen, but it does work great as a rescue treatment. I do often recommend letting kids soak and play in the bathtub as long as they want and then smearing their whole body with a good moisturizer upon exiting.  Then apply medicine to the rash areas only.  I find this plan more useful for the average patient. 

In a previous article, we discussed what ingredients to look for in moisturizers and those tips apply to patients with atopic dermatitis as well. 

This is Part 2 of a 5 part article about atopic dermatitis. To learn more about atopic dermatitis, see our prior article, Part 1.

—————–

If you know someone who may find this article helpful, please share it with them! Follow us on social media this week, and subscribe to our growing YouTube channel! If you would like to receive these posts in your email inbox, Subscribe to our Site.