For many of us, washing is an important daily ritual which plays many roles in our day-to-day life, whether it is helping you feel refreshed on an early start or unwind after a busy day, washing helps not only clean our bodies but also our minds. Unfortunately for people with AD washing without taking the necessary precautions can be a significant exacerbator of the condition. 

When washing it is important to remember two of the three major factors driving the condition.

Skin barrier dysfunction with a predisposition to moisture loss

Hypersensitivity to irritants

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Both of these can easily be exacerbated or triggered during normal cleansing/washing.

Exacerbating skin water loss

Though it seems logical that submersing our bodies in water would hydrate the skin, in practice washing tends to do the opposite. 

Surfactants (chemicals in soaps) remove dirt, aid in exfoliation and help dissolve oils, but also strip the skin of its natural oils (a natural barrier to water loss).

Soaps and cleansers also bind to proteins in the skin, this initially leads to skin swelling and hyper-hydration while washing. However, this moisture rapidly evaporates afterwards with the skin returning to a state of lower hydration within 5-10 minutes (this explains the dry tight skin sensation you experience after washing).

Excessively hot and prolonged showers and baths also increase skin dryness with studies showing a direct relationship between increased water temperature during washing and increased skin water loss.

Exposing the skin to irritants

Soaps and cleansers have a dual action on exacerbating skin irritation both through direct damage to skin integrity and facilitating easier and deeper penetration of other irritating chemicals into the skin.

Soaps which are alkaline in nature (typical non-synthetic soap bars) have a greater potential to irritate the skin.

The content of soaps is highly variable and you may have found one that works for you but in general dermatologists recommend avoiding strong soaps (especially those that haven’t been designed for sensitive skin). 

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How to wash with AD

Firstly washing is important and facilitates the exfoliation of dead skin, removal of dirt/chemicals and reduces the bacterial load on the skin.  

Any moisturiser can be used as a soap substitute where it acts as a moisturising cleanser - simultaneously helping clean the skin while depositing protective oils to lock in moisture.

If you need to use soaps, syndets (synthetic detergents) and mild moisturising body washes tend to have a neutral pH and do less skin damage.

Some individuals like to cover themselves in their soap substitute before getting into the bath or shower and then gently rinse off while washing, the moisturiser acts as both a protective barrier from irritants and locks in moisture. 

Moisturising immediately after washing prevents water loss and helps rehydrate the skin.

If bathing try to add an emollient or other oils to the water, these products will adhere to the skin after bathing, acting as a protective barrier and hydrating the skin.

Oatmilk bathing can be beneficial due to oats enhancing moisture uptake, acting as a natural cleanser and having anti-inflammatory properties.  

Try to avoid hard water, which has been shown to increase itchiness and skin irritation.

Water additives for bathers:

Dead sea water

Oatmilk/oats

Cold-pressed natural oils