For many individuals with eczema, the use of topical medications and other more potent measures of treatment are often the go to remedies that they first think of. However, sometimes managing eczema is just as simple as following a daily skincare routine of bathing and moisturizing. We often think of these two behaviors as trivial acts, but they are by far the most crucial steps in helping us promote a healthy skin barrier.

The Skin Barrier

When we refer to the skin barrier, we often mean the outermost layer of our skin that when functioning, prevents transepidermal water loss and keeps irritants and allergens out. The skin barrier is often very resilient and is composed of stacked epidermal cells interspersed with protective lipids/fats. Maintaining a healthy skin barrier helps ensure that your body’s first line of defense against damaging environmental elements, including chemical irritants, bacteria, and other microbes, is functioning as it should. This helps reduce the likelihood of experiencing inflammation due to immune responses to bacterial invasion. More importantly, a healthy skin barrier works to keep moisture in, keeping skin hydrated and less prone to irritation caused by dry, itchy skin.

A Compromised Skin Barrier

While your skin barrier is resilient, it is also very delicate and can be damaged by a number of factors, including environmental stress, harsh cleansers, and other forms of physical harm to the skin (such as scratching or rubbing). Cellular water loss can lead to sensitized and dehydrated skin that becomes more susceptible to irritation and inflammation, resulting in an increased risk of having an eczema flare. The key to managing eczema is thus to first and foremost protect the skin barrier from any unnecessary damage. This starts with properly cleaning and moisturizing the skin on a daily basis.

Keeping the Skin Clean

For individuals with eczema, more than just bathing/showering regularly, it is just as important, if not more, to know the proper way of cleaning your skin. The following are some bathing techniques that are recommended for individuals with eczema. It is important to keep these details in mind, because if not done properly, bathing/showering can do more harm than good to your skin.

“Soak and Seal” Method

1. Bathe with lukewarm water, using mild fragrance-free cleanser (avoid harsh soaps).

2. Soak for 5-10min; avoid scrubbing/rubbing skin.

3. Lightly pat dry skin with a towel leaving it slightly damp.

4. Apply prescription topical medication to the affected areas of skin as directed.

5. Within three minutes, liberally apply a moisturizer all over the body.

6. Wait a few minutes to let the moisturizer absorb into the skin before dressing or applying wet wraps.

When following the above recommended steps, both bathing and showering are equally effective. The key is to only use lukewarm water, avoid scrubbing, and really try not to overwash without proper follow-up moisturization.

Bleach Baths

Besides the regular “Soak and Seal” method of bathing, bleach baths have also been found to be an effective way to decrease inflammation and the amount of bacteria on the skin. An eczema bleach bath works by killing the bacteria on your skin and effectively reducing itching, redness, and scaling. However, if you have bleach sensitivities or allergic asthma that may be triggered by chlorine fumes, it is not recommended for you to do bleach baths. In general, bleach baths should only be done two to three times a week and it is best to consult with a physician before use if you have any concerns.

Instructions:

1. Fill the bathtub with lukewarm water.

2. Add ½ cup of regular/unconcentrated household bleach (usually around 6% sodium hypochlorite) to a full standard-size bathtub of water (approximately 40 gallons)

   • Alternatives:

     • ¼ cup for a half bathtub of water (approximately 20 gallons)

     • 1 teaspoon of bleach per gallon of water for a baby bathtub

3. Soak for 10 minutes (do not submerge head or face under water).

4. Rinse off completely with warm tap water and pat dry skin.

5. Proceed with daily skincare routine, immediately applying any required topical medications and moisturize liberally.

Moisturizing

“All moisturizers are not created equal.”

Moisturizing adequately after bathing or showering is crucial in locking in water and preventing the moisture from evaporating, making the skin even drier than before the bath/shower. Just as it is important to know the proper way of bathing, knowing what kinds of moisturizers work best for you is just as important. Moisturizers are separated into three basic types: ointments, creams, and lotions. As a general rule of thumb, heavier moisturizers that are high in oil content are most suitable in treating eczema. As such, the moisturizer hierarchy goes as follows, from most effective to least effective: ointments → creams → lotions.

• Ointments: have the highest oil content and often contain petroleum jelly and mineral oils

• Creams: contain less oil and are less greasy to the touch

• Lotions: primarily made of water, so evaporate quickly

Another Alternative: Skin Barrier Creams

Skin barrier creams are infused with lipids and ceramides, which are often found in healthy skin barriers. These naturally occurring substances help form a protective layer on the outermost layer of our skin, which subsequently helps to lock in moisture while keeping out impurities, allowing for the skin to heal from any recent flares.

Take Home Message

Your body itself contains many of the building blocks needed to help maintain a healthy skin barrier. While topical medications and other forms of more potent treatments help with more severe cases of eczema, sometimes all your skin really needs is some extra moisturization. Maintaining a routine bathing and moisturizing schedule may just be that extra push your skin needs to help rejuvenate itself.