To improve the counseling provided to the patient on maximizing skin hydration and moisturization review

  • Gutman AB, Kligman AM, Sciacca J, James WD. Soak and smear. Arch Dermatol. 2005; 141:1556-1559.  Soak and Smear
  • Hajar T, Hanifin JM, Tofte SJ, Sampson EL. Prehydration is effective for rapid control of recalcitrant atopic dermatitis. Dermatitis. 2014; 25: 56-59.  Prehydration

Recommendations on the use of bathing in the treatment atopic dermatitis (AD) vary widely among pediatricians and specialists.  These recommendations may be generally divided into two camps: those who favor bathing in AD vs. those who restrict bathing in AD.  Although there are few controlled studies on this subject, the available data and clinical experience support the use of bathing for 15 to 20 minutes followed by gentle patting of skin and application of moisturizers/topical medications.  
Gutman et al. (1) showed that soaking in a bath for 20 minutes followed by immediate ointment application to wet skin leads to improvement or clearing of eczema in patients with refractory AD.  This is known as the “soak and smear” method.  More recently, the group of Hanifin and Sampson showed that bathing 15 to 20 minutes followed by application of topical medication within 3 minutes significantly improve patients with severe, recalcitrant AD (2).  Although further controlled studies are needed to compare the frequency and duration of bathing in the treatment of AD, available data supports the recommendation of pre-hydration therapy as outlined above in the topical treatments of AD patients.