Bathing, Moisturizing and Wet Wraps
People with eczema tend to have very dry skin in general. This is because the disease causes defects in the stratum corneum, or the skin barrier. The skin barrier is the outermost layer of the skin that serves a dual purpose: it protects irritants, bacteria, viruses and allergens from getting into our bodies and it keeps moisture from getting out. Genes, skin trauma — such as from scratching or rubbing — and inflammation caused by the immune system can all contribute to this defective or “leaky” skin barrier in people with eczema.
The most effective way to treat dry skin is to give it the moisture it needs and help it to retain it. Proper bathing and moisturizing are important for this reason — especially if you have eczema. The best way to replace and retain moisture in the skin is to moisturize immediately after taking a bath or shower.
Tips for bathing and moisturizing with eczema
Although there have not been comparative studies to pinpoint the best frequency or duration of bathing, the “Soak and Seal” method of treating eczema is recommended by many healthcare providers to combat dry skin and reduce flares.
To get the full therapeutic benefit of Soak and Seal, follow these steps in order:
- Bathe or shower in lukewarm (not hot) water for a short period of time (about 5-10 minutes) at least once per day.
- Avoid scrubbing your skin with a washcloth or loofah.
- Use a gentle cleanser (not soap) that is unscented, fragrance-free and dye-free.
- Lightly pat dry with a towel leaving the skin damp. Do not rub the skin.
- Apply prescription topical medication to the affected areas of skin as directed.
- Liberally apply a high-oil content moisturizer all over the body to seal in moisture. Try to do this within 3 minutes to limit the amount of moisture lost from the skin.
- Let the moisturizer absorb into the skin for a few minutes before dressing or applying wet wraps. Wear cotton gloves over your hands while you sleep to help lock in the moisturizer and prevent scratching.
Not only will soaking in a tub of warm (not hot) water help your skin better absorb moisture, bathing can also relax your body and mind and help ease stress.
There are also specific bath treatments that can relieve eczema symptoms such as:
Using gentle oils in your bathwater can help keep you moisturized. Be sure to use oils that do not contain fragrances.
Adding a quarter-cup of baking soda to your bath, or applying it to the skin directly in the form of a paste, is a common treatment used to help relieve itching.
Data suggests mild bleach and water solution can decrease inflammation, itching and potentially the amount of Staphylococcus aureus bacteria on the skin, which can lead to skin infections in eczema. Use a half-cup of household bleach for a full tub of water, one-quarter cup for a half tub. Soak up to 10 minutes, then rinse off. Some healthcare providers suggest doing these two to three times per week.
People with bleach sensitivities or allergic asthma that might be aggravated by chlorine fumes should consult with their healthcare provider before starting bleach bath therapy.
Adding colloidal oatmeal to your bath, or applying it to the skin directly in the form of a paste, is also a common treatment used to help relieve itching.
If you’re experiencing a severe flare, bathing may cause your skin to sting. Adding one cup of table salt to your bath water can help ease this symptom.
Apple Cider Vinegar
Add between one cup and one pint of vinegar to the bath. This also can be used as a wet dressing, as the vinegar is believed to have antimicrobial effects.
Get the Facts on apple cider vinegar for eczema.
Controlling eczema by moisturizing
Keeping your skin’s moisture intact is one of the most important things you can do to help control your eczema. It’s important to understand how and when to properly moisturize and which products are best to use when you have eczema.
Tips when moisturizing
- If you use a prescription topical medication, apply it as directed, before you moisturize.
- Apply a thick layer of moisturizer all over your skin within three minutes of bathing or showering to lock in moisture and protect the skin barrier.
- Moisturize your skin at least twice a day.
- Soften moisturizer by rubbing it between your hands and then apply it to your body using the palm of your hand.
- If the moisturizer feels tacky on your skin, don’t remove the excess. It will be absorbed within a few minutes.
- Moisturize your hands every time you wash them or when they come into contact with water.
Finding the right moisturizer
Finding a moisturizer that works can be a challenge. What works for one person may not work for another and as the condition of your skin changes, so can the effectiveness of a product. A manufacturer may also change the formulation of a product periodically as well.
Start with the National Eczema Association Seal of Acceptance™ to find moisturizers free of fragrance, dyes and other common allergens. Products on this list are recognized by NEA as suitable for care of eczema or sensitive skin. Moisturizers are classified as ointments, creams, lotions or skin barrier repair creams based on the amount of oil and water they contain. The more oil in a moisturizer, the better it usually is at treating eczema.
Ointments such as petroleum jelly and mineral oil are usually the first choice for eczema treatment as they have the highest oil content and are very good at sealing in moisture. If you don’t like how ointments feel on your skin, the next best alternative is a cream.
Creams are second to ointments in the amount of oil they contain and are also very good at sealing in moisture. Because they contain less oil, they are also less greasy to the touch. Be sure to read labels carefully — creams sometimes contain stabilizers or preservatives that can irritate your skin.
Lotions contain the least amount of oil. Because they are primarily made of water, lotions evaporate quickly and may contain preservatives that burn when applied to skin that’s scratched or broken. If your skin stings or burns after you apply a lotion, switching to a cream or ointment may help.
Skin Barrier Repair Creams
Skin barrier repair creams are available by prescription and over the counter. They are infused with lipids and ceramides, which are naturally occurring substances found in healthy skin barriers that skin with eczema may lack. The lipids and ceramides found in skin barrier moisturizers form a protective layer on the skin to help lock in moisture while keeping out irritants. This allows eczema skin to heal and become more resistant to symptoms, including burning, dryness and itch.
Wet Wrap Therapy
During particularly intense eczema ﬂares with severe itch or pain, wet wrap therapy can work wonders to rehydrate and calm the skin and help topical medications work better. The fabric wraps are soaked in water and applied to the affected skin on the body. While wet wrap therapy can be done at home, wet wraps specifically applied to the face use gauze and surgical netting and should be applied by medical professionals trained in this treatment.
Wet wraps are best done after bathing, moisturizing and applying medication. Use clean, preferably white, cotton clothing or gauze from a roll for the wet layer, and pajamas or a sweat suit on top as a dry layer. If the eczema is on the feet and/or hands, you can use cotton gloves or socks for the wet layer with vinyl gloves or food-grade plastic wrap as the dry layer.
To do wet wrap therapy, first moisten the clothing or gauze in warm water until they are slightly damp. Next, wrap the moist dressing around the affected area. Then gently wrap the dry layer over the wet one. Lastly, carefully put on loose-fitting clothing so as not to disturb the dressing. Leave wet wraps on for several hours or overnight, taking care not to let them dry out.
Consult with a healthcare provider before starting wet wrap therapy.
Download our wet wrap therapy instruction sheet.