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.

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.

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.

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, we need 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 Vaseline), and put on pure cotton gloves before going to sleep.

Basic skin care can enhance the effect of prescription drugs, and it can prevent or minimize the severity of eczema relapse.

Take at least one bath or shower per day. Use warm, not hot, water for at least 5 to 10 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 3 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). Used correctly, these medications are safe and effective. (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. Vaseline® is a good occlusive preparation to seal in the water; however, it contains no water so it only works effectively after a soaking bath.

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.

• Skin is frequently wet without the immediate application of an effective moisturizer.
• Moisture evaporates, causing the skin barrier to become dry and irritated.

• After skin is wet, an effective moisturizer is applied within 3 minutes.
• Hydration is retained, keeping the skin barrier intact and flexible.

Gently cleanse your skin each day.

Use mild, non-soap cleansers.

Use fragrance-free, dye-free, neutral-pH (pH lower than 5.5) soaps.

Moisturize immediately after cleansing while your skin is still wet.

Avoid scrubbing with a washcloth or towel; pat instead.

Our skin is not nearly as alkaline as most soap is: our skin’s normal pH is about 4 to 5.5 and the average pH of soap is 9 to 10.5. So, you see, soap is actually not recommended.

Following are a few non-soap cleanser suggestions:

• Aquaphor® Gentle Wash
• AVEENO® Advanced Care Wash
• Basis® Sensitive Skin Bar
• CeraVe™ Hydrating Cleanser
• Cetaphil® Gentle Cleansing Bar
• Dove® Sensitive Skin Unscented Beauty Bar
• Mustela® Stelatopia Cream Cleanser
• Oilatum® Cleansing Bar

Aggressive scrubbing

Use of astringents

Cleansing without moisturizing

Use of harsh soap-based cleansers

• Harsh surfactants can damage epidermal barrier.
• Soaps with an alkaline pH can further disrupt skin barrier proteins and lipids.

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 microorganisms

Desquamated keratinocytes (dead skin cells that are the normal product of skin maturation)

Cosmetics, skin care products, medications

Short baths or showers (no more than 5 to10 minutes) keep the skin from drying out.

Keep the water comfortably warm, not hot or cold. Hot water dries skin quickly, so be sure to use lukewarm water.

Do NOT rub your skin.

Do NOT completely dry your skin after your bath or shower. Instead, pat yourself lightly with a towel if needed.

A soak in a tub of lukewarm water for 10 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. Soak for about 10 minutes and rinse off. Use 2-3 times per week. Bleach baths decrease the bacteria on the skin and decrease bacterial skin infections. Use 1/2 cup household bleach for a full bathtub, 1/4 for a half bath.

Vinegar Baths: Referred to as the “pickle the patient” treatment. 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: Added to a bath or made into a paste it can be used to relieve the itching.

Tar Baths: Tar baths can sooth inflammation and itch. Tar bath oil or tar shampoo can be used. Warning: if the skin is open or excoriated the tar baths can sting.

Oatmeal baths: Added to a bath or made into a paste it can be used to relieve the itching.

Moisturizing improves skin hydration and barrier function.

Moisturizers are more effective when applied to skin that has been soaked in water.

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 and more liked. A warning: creams often contain stabilizers and preservatives to prevent separation of their main ingredients, and these additives can cause skin irritation 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.

Following are a few suggestions:

• Aquaphor® Healing Ointment
• AVEENO® Advanced Care Cream
• Crisco Regular Shortening
• CeraVe™ Moisturizing Cream
• Cetaphil® Moisturizing Cream
• Eucerin® Original Creme
• Moisturel® Therapeutic Cream
• Mustela® Stelatopia Moisturizing 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. All of these moisturizers should be available through your local pharmacy or grocery store. If you don’t see one on the shelf, ask the 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.

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.

Take a glob 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.

After bathing and moisturizing, the next important step is to attempt to 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 soap 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, 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.

The National Eczema Association (NEA) thanks Anna L. Bruckner, MD, Sarah Chamlin, MD, and Sandra Oehlke, CPNP, for their editorial contributions.

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.