Washing / Hygiene
Washing / Hygiene
Washing / Hygiene
Washing / Hygiene
Washing / Hygiene
Washing / Hygiene
Washing / Hygiene
Washing / Hygiene
Washing / Hygiene
Washing / Hygiene
Washing / Hygiene
Washing / Hygiene
Washing / Hygiene
Washing / Hygiene
Washing / Hygiene
Washing / Hygiene
While it may seem logical that immersing our bodies in water would hydrate the skin, in practice, washing tends to have the opposite effect and can significantly contribute to dry skin.

Washing / Hygiene

Written By:

Dr Thomas Anderson - GMC 7493075

July 5, 2023

For many of us, washing is an important daily ritual that serves various roles in our day-to-day lives. Whether it helps us feel refreshed at an early start or unwind after a busy day, washing not only cleanses our bodies but also our minds. Unfortunately, for people with eczema/atopic dermatitis, washing without taking necessary precautions can significantly exacerbate the condition, leading to dry, irritated skin and eczema flare-ups.

Before delving into discussions about soaps, shower gels, cleansers, etc., it's worth taking some time to understand what happens to our skin when we wash.

When washing, it's crucial to remember two of the three major factors of eczema-prone skin:

1. Skin barrier dysfunction with a predisposition to moisture loss.

2. Hypersensitivity to irritants.

Both of these can easily occur during normal cleansing/washing, leading to dry skin and triggering eczema symptoms.

Exacerbating skin water loss

While it may seem logical that immersing our bodies in water would hydrate the skin, in practice, washing tends to have the opposite effect and can significantly contribute to dry skin.

Surfactants, chemicals found in soaps, serve to remove dirt, aid in exfoliation, and help dissolve oils. However, they also strip the skin of its natural oils, which act as a barrier to water loss.

Moreover, soaps and cleansers bind to proteins in the skin, initially causing skin swelling and hyper-hydration during washing. However, this moisture rapidly evaporates afterward, leading the skin to return to a state of lower hydration within 5-10 minutes. This phenomenon explains the dry, tight skin sensation experienced after washing.

Additionally, excessively hot and prolonged showers and baths further exacerbate skin dryness. Studies have shown a direct relationship between increased water temperature during washing and heightened skin water loss.

Exposing the skin to irritants

Soaps, cleansers, bubble baths, and many bath water additives can exacerbate skin irritation through a dual action: direct damage to skin integrity and facilitation of easier and deeper penetration of other irritating chemicals into the skin.

The skin is naturally acidic, whereas most soaps are alkaline. The higher the alkalinity of the soap, the more easily it penetrates the skin barrier, leading to skin irritation and itch. Bar soaps tend to be more alkaline and therefore more damaging to the skin, while synthetic detergents tend to be more neutral compared to natural cleansers, especially those containing tallow and animal fats.

The composition of soaps varies widely, requiring a balance of several independent factors, including pH, the strength of the cleanser, and the presence of other chemicals such as perfumes. For individuals with sensitive skin, dermatologists generally recommend mild cleansers that are perfume-free and have a neutral pH.

Other factors

It's also worth noting that increased skin temperature can heighten the sensation of skin itchiness. Therefore, washing or bathing with hot water may lead to skin itchiness, stimulating the urge to scratch and potentially causing damage to delicate eczema-prone skin.

How to wash with AD

Washing is important for facilitating the exfoliation of dead skin, removing dirt and chemicals, and reducing the bacterial load on the skin. This reduction not only lowers the risk of infections but also decreases the concentration of commensal bacteria on the skin, such as Staphylococcus aureus, which is believed to contribute to eczema flares.

Soaps and soap substitutes

Any moisturiser can serve as a soap substitute, acting as a moisturising cleanser that helps clean the skin while depositing protective oils to lock in moisture. Some individuals prefer to apply their moisturiser before bathing or showering, covering themselves in it and then gently rinsing off while washing. This method creates a protective barrier from irritants and effectively locks in moisture.

If you find the need to use soaps, such as when dealing with strong body odour, syndets (synthetic detergents) and mild moisturising body washes with a neutral pH tend to cause less skin damage. However, it's important to be cautious of the strength of the cleanser. As a general rule, opting for brands that specialise in products for delicate skin, such as Cetaphil, Aveeno, and Cerave, is a good place to start.

Water temperature and hardness

Avoiding very hot showers or baths is advisable; instead, opt for lukewarm water. Warm water (vs hot water) not only reduces skin warming but also lessens soap penetration into the skin. Furthermore the longer you spend in the 

Though there is no robust evidence to support any direct benefit of using water softeners, some individuals report worsening eczema symptoms when washing in hard water. It is thought this may be due to soaps being harder to foam/lather in hard water leading to more soap use and therefore more skin damage. Given the lack of scientific evidence to support water softeners we wouldn't usually recommend the investment. 

Bath additives for bathers:

When bathing, consider adding an emollient or bath oil to the water. These products will adhere to the skin after bathing, acting as a protective barrier minimising skin water loss. However, be cautious, as this may make the bath more slippery and potentially dangerous.

Specific bath additives which have been shown to positively impact sensitive eczema prone-skin include oat-milk, Dead Sea salt and bleach bathing.

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

Dead Sea salt is high in magnesium and has been shown to improve skin barrier function, increase skin hydration and reduce inflammation. 

Bathing in dilute bleach (sodium hypochlorite) has been shown to reduce skin colonisation of staph aureus while also having possible anti-inflammatory effects on 

Post washing skin care:

When drying the skin, pat it dry with a soft towel. Vigorous rubbing with a rough towel can lead to skin trauma and irritation.

If you are using a soap or gentle cleanser, moisturising immediately after washing is crucial. This is the time of greatest water loss from the skin. Using your moisturiser prevents water loss and helps rehydrate the skin.


What is the best shower gel to use if you have eczema?

As mentioned above, typical shower gels, soaps, and body washes should generally be avoided if you suffer from eczema, atopic dermatitis, or sensitive skin. This is because of the strength and alkaline nature of these products. We recommend sticking to sensitive cleansers made by companies specialising in eczema care or using your moisturiser as a soap substitute.

What is better for the skin, showering or bathing?

Several factors influence this decision. Firstly, people tend to bathe for longer durations than they shower, leading to increased water loss and a rise in skin temperature. Additionally, when bathing, there is increased skin contact with soap, as it dissolves into the bathwater, enhancing its ability to penetrate the skin. Therefore, showering is generally considered better, as showers tend to be shorter and reduce skin contact time with soap.

Is it ok to add bubble bath to bath water if I have eczema?

Generally, we advise against using bubble bath if you have eczema. The soaps in the product can be damaging to the skin, and bubble baths often contain perfumes that can irritate the skin further.

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