Bathing & Moisturizing
What is eczema?
Eczema is a chronic recurring skin disorder that results in dry, easily irritated, itchy skin. There is no cure for eczema, but good daily skin care is essential to controlling the disease.
What are the characteristics of dry skin?
When your skin is dry, it is not because it lacks grease or oil, but because it fails to retain water. For this reason, a good daily skin care regimen focuses on the basics of bathing and moisturizing.
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What other factors create dry skin?
Wind, low humidity, cold temperature, excessive washing without use of moisturizers, and use of harsh, drying soaps can all cause dry skin and aggravate eczema.
How do I take care of my dry skin?
The most important treatment for dry skin is to put water back in it. The best way to get water into your skin is to briefly soak in a bath or shower and to moisturize immediately afterwards.
Use of an effective moisturizer several times every day improves skin hydration and barrier function. Moisturizer should be applied to the hands every time they are washed or in contact with water.
The goal of bathing and moisturizing is to help heal the skin. To repair the skin, it is necessary to decrease water loss.
Some dermatologists recommend that you perform your bathing and moisturizing regime at night just before going to bed. You are unlikely to further dry out or irritate your skin while sleeping, so the water can be more thoroughly absorbed into your skin.
If you have hand eczema dermatologists recommend that you soak your hands in water, apply prescription medications and moisturizer (preferably an oinment), and put on pure cotton gloves before going to sleep.
If I am on prescription drugs for my eczema, do I still need to moisturize?
Basic skin care can enhance the effect of prescription drugs, and it can prevent or minimize the severity of eczema relapse.
What are the basics of Bathing & Moisturizing?
TAKE AT LEAST ONE BATH OR SHOWER PER DAY. Use warm, not hot, water for at least 10 to 15 minutes. Avoid scrubbing your skin with a washcloth.
USE A GENTLE CLEANSING BAR OR WASH, NO SOAP. During a severe flare, you may choose to limit the use of cleansers to avoid possible irritation.
WHILE YOUR SKIN IS STILL WET (within three minutes of taking a bath or shower), apply any special skin medications prescribed for you and then liberally apply a moisturizer. This will seal in the water and make the skin less dry and itchy.
BE SURE TO APPLY ANY SPECIAL SKIN MEDICATIONS TO AREAS AFFECTED WITH ECZEMA BEFORE MOISTURIZING. The most common skin medications used to treat skin inflammation are prescription and non-prescription topical steroids or prescription topical immunomodulators (TIMS). Be sure to use these medications as directed. Remember that TIMS can sting if applied to wet skin, so apply a thin coat to affected areas only.
BE SURE TO APPLY MOISTURIZER ON ALL AREAS OF YOUR SKIN WHETHER IT HAS OR HAS NOT BEEN TREATED WITH MEDICATION. Specific occlusives or moisturizers may be individually recommended for you.
MOISTURIZERS ARE AVAILABLE IN MANY FORMS. Creams and ointments are more beneficial than lotions. Petroleum jelly is a good occlusive preparation to seal in the water; however, since it contains no water it works best after a soaking bath.
How does water help my skin?
- Water hydrates the stratum corneum (the top layer of skin).
- Water softens skin so the topical medications and moisturizers can be absorbed.
- Water removes allergens and irritants.
- Water cleanses, debrides, and removes crusted tissue.
- Water is relaxing and reduces stress.
Is water an irritant or a treatment?
Water IRRITATES skin IF…
- Skin is frequently wet without the immediate application of an effective moisturizer.
- Moisture evaporates, causing the skin barrier to become dry and irritated.
Water HYDRATES skin IF…
- After skin is wet, an effective moisturizer is applied within 3 minutes.
- Hydration is retained, keeping the skin barrier intact and flexible.
What are some cleansing tips?
- Gently cleanse your skin each day.
- Use mild, non-soap cleansers.
- Use fragrance-free, dye-free, low-pH (less than 5.5) cleansing products.
- Moisturize immediately after cleansing while your skin is still wet.
- Avoid scrubbing with a washcloth or towel; pat instead.
What cleansing product should I use?
Our skin surface is much more acidic than soap: the average pH of soap is 9 – 10.5 while the normal pH of skin is 4 – 5.5. Some non-soap cleansers are specially formulated with a lower pH to be less irritating. Following are a few suggestions:
- Aquaphor® Gentle Wash & Shampoo
- AVEENO® Baby Cleansing Therapy Moisturizing Wash
- Basis® Sensitive Skin Bar
- Bella Dry Skin Formula Moisturizing Body Bar
- CeraVe™ Hydrating Cleanser
- Cetaphil® Restoraderm® Body Wash
- Cetaphil® Gentle Skin Cleanser
- CLn® Body Wash
- Dove® Sensitive Skin Unscented Beauty Bar
- Eucerin® Calming Body Wash
- Exederm® Cleansing Wash
- Kiss of Nature Oh My Baby!! Moisturizing Castile Body Bar
- Mustela® Stelatopia Cream Cleanser
- MD Moms® Baby Silk Gentle All-Over Clean Hair & Body Wash
- Neosporin® Moisture Essentials Daily Body Wash
- Oilatum® Cleansing Bar
- Vanicream™ Cleansing Bar or Free & Clear Liquid Cleanse
What does cleansing remove?
- Sebum (an oily substance produced by certain glands in the skin)
- Apocrine and eccrine secretions (skin gland secretions, discarded cells)
- Environmental dirt
- Bacteria, fungus, yeast and other germs
- Desquamated keratinocytes (dead skin cells that are the normal product of skin maturation)
- Cosmetics, skin care products, medications
What is preferable, a bath or a shower? For how long?
Either a bath or shower (about 10 – 15 minutes long) will keep the skin from drying out.
DO NOT rub your skin.
DO NOT completely dry your skin after your shower or bath. Instead, pat yourself lightly with a towel if needed.
What type of bath should I take?
A soak in a tub of lukewarm water for 10 – 15 minutes will help the skin absorb water. You may wish to try one of the following for specific treatment:
BLEACH BATHS: Bleach baths make the tub into a swimming pool! Soak for about 10 minutes and rinse off. Use 2 – 3 times a week. Bleach baths decrease the bacteria on the skin and decrease bacterial skin infections. Use ½ cup household bleach for a full bathtub, ¼ cup for a half bath.
VINEGAR BATHS: Add one cup to one pint of vinegar to the bath. Can be used as a wet dressing too as it kills bacteria.
BATH OIL BATHS: Oils in the bath are a favorite of some providers and patients. Bath oils can leave the tub slippery—be careful. They can also leave a hard-to-clean film. See if they work for you.
SALT BATHS: When there is a significant flare the bath water may sting or be uncomfortable. Add one cup of table salt to the bath water to decrease this side effect.
BAKING SODA BATHS: Baking soda added to a bath or made into a paste can be used to relieve the itching.
OATMEAL BATHS: Oatmeal added to a bath or made into a paste can be used to relieve the itching.
What does moisturizing do?
Moisturizing improves skin hydration and barrier function.
Moisturizers are more effective when applied to skin that has been soaked in water.
What are the different kinds of moisturizers?
There are three basic classes of moisturizers:
OINTMENTS are semi-solid greases that help to hydrate the skin by preventing water loss. Petroleum jelly has no additional ingredients,whereas other ointments contain a small proportion of water or other ingredients to make the ointment more spreadable. Ointments are very good at helping the skin retain moisture but they are often disliked because of their greasiness.
CREAMS are thick mixtures of greases in water or another liquid. They contain a lower proportion of grease than ointments, making them less greasy. A warning: creams often contain stabilizers and preservatives to prevent separation of their main ingredients, and these additives can cause skin irritation or even allergic reactions for some people.
LOTIONS are mixtures of oil and water, with water being the main ingredient. Most lotions do not function well as moisturizers for people with dry skin conditions because the water in the lotion evaporates quickly.
What moisturizer should I use?
The importance of moisturizing cannot be over emphasized as a treatment for eczema and sensitive skin. Moisturizers maintain skin hydration and barrier function. Generic petroleum jelly and mineral oil (without additives) are two of the safest, most effective moisturizing products.
Following are a few suggestions:
- Albolene Moisturizing Cleanser®
- Aquaphor® Healing Ointment
- AVEENO® Eczema Therapy Moisturizing Cream
- CeraVe™ Moisturizing Lotion or Cream
- Cetaphil® Moisturizing Cream
- Cetaphil® Restoraderm® Moisturizer
- Crisco Regular Shortening
- Curél Itch Defense Skin Balancing Moisture Lotion
- Eucerin® Calming Creme or Original Cream
- Exederm® Intensive Moisture Cream
- La Roche-Posay® Lipikar Balm
- MD Moms® Baby Silk Daily Skin Protection Moisturizing Balm
- Moisturel® Therapeutic Cream
- Mustela® Stelatopia Moisturizing Cream
- Neosporin® Eczema Essentials Daily Moisturizing Cream
- Theraplex® Emollient or Lotion
- Triple Cream®
- Vanicream™ Moisturizing Skin Cream
- Vaseline® Petroleum Jelly
Apply moisturizer to your skin immediately after your bath or shower and throughout the day whenever your skin feels dry or itchy. Some people prefer to use creams and lotions during the day and ointments and creams at night. If you can’t find the product you want, ask a pharmacist to order it for you in the largest container available. Buying your moisturizers in large containers like one-pound jars may save you a great deal of money.
What are proper moisturizing techniques?
- Just as it is important to use proper bathing techniques, it is important to properly apply moisturizers to your skin within three minutes of showering or bathing.
- While your skin is still wet, apply prescription medications, and then apply a moisturizer to all your skin.
- A thick bland product is best.
- Dispense the moisturizer from large jars with a clean spoon, butter knife, or pump to avoid contamination.
- Take a dollop of moisturizer from the jar, soften it by rubbing it between your hands, and apply it using the palm of your hand stroking in a downward direction.
- Do NOT rub by stroking up and down or around in circles.
- Leave a tacky film of moisturizer on your skin; it will be absorbed in a few minutes.
Everyone has different preferences concerning how products feel on their skin, so try different products until you find one that feels comfortable. Continue use of the moisturizer(s) even after the affected area heals to prevent recurrence.
How can I reduce skin irritation?
DON’T SCRATCH OR RUB THE SKIN. These actions can worsen any itch. Instead, apply a moisturizer whenever the skin feels dry or itchy. A cool gel pack can provide some relief from itch.
WASH ALL NEW CLOTHES BEFORE WEARING THEM. This removes formaldehyde and other potentially irritating chemicals which are used during production and packing.
ADD A SECOND RINSE CYCLE TO ENSURE THE REMOVAL OF SOAP IF YOU ARE CONCERNED. Use a mild detergent that is dye-free and fragrance-free.
WEAR GARMENTS THAT ALLOW AIR TO PASS FREELY TO YOUR SKIN. Open-weave, loose-fitting, cotton-blend clothing may be most comfortable. Avoid wearing wool.
WET WRAP THERAPY CAN EFFECTIVELY REHYDRATE AND CALM THE SKIN. Soak in a bath, and then apply moisturizer. Medication should also be applied if currently prescribed. The bandages, moistened in warm water until they are slightly damp, are then wrapped around the area. Dry bandages are wrapped over the wet bandages. In place of bandages, athletic socks, or moistened pajamas worn underneath a set of dry pajamas can be used with children and infants.
WORK AND SLEEP IN COMFORTABLE SURROUNDINGS with a fairly constant temperature and humidity level. Cooler temperatures are preferred but not so cool as to initiate chilling.
KEEP FINGERNAILS VERY SHORT AND SMOOTH by filing them daily to help prevent damage due to scratching.
MAKE APPROPRIATE USE OF SEDATING ANTIHISTAMINES, which may reduce itching to some degree through their tranquilizing and sedative effects.
USE SUNSCREEN ON A REGULAR BASIS AND ALWAYS AVOID GETTING SUNBURNED. Use a sunscreen with an SPF of 15 or higher. Sunscreens made for the face are often less irritating than regular sunscreens. Zinc oxide or titanium dioxide–based products are less irritating.
GO FOR A SWIM, which can provide good hydration. Chlorine can also decrease bacteria on the skin that can cause itching or develop into an infection. Of course, residual chlorine or bromine left on the skin after swimming in a pool or hot tub may be irritating, so take a quick shower or bath immediately after swimming, washing with a mild cleanser from head to toe, and then apply an appropriate moisturizer while still wet.
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This information sets forth current opinions from recognized authorities, but it does not dictate an exclusive treatment course. Persons with questions about a medical condition should consult a physician who is knowledgeable about that condition.
The National Eczema Association (NEA) improves the health and quality of life for individuals with eczema through research, support, and education. NEA is entirely supported through individual and corporate contributions and is a 501(c)(3) tax-exempt organization. NEA is the only organization in the United States advocating solely for eczema patients.
Acknowledgments: The National Eczema Association (NEA) acknowledges Anna L. Bruckner, MD, Sarah Chamlin, MD, and Sandra Oehlke, CPNP, for their editorial contributions to this brochure.
Copyright © 2012 National Eczema Association