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. image 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. image Prehydration
  • Cardona ID, Kempe EE, Lary C, Ginder JH, Jain N. (2020). Frequent Versus Infrequent Bathing in Pediatric Atopic Dermatitis: A Randomized Clinical Trial. J Allergy Clin Immunol Pract 8, 1014-1021. 
  • Bakaa L, Pernica JM, Couban RJ, Tackett KJ, Burkhart CN, Leins L, et al. Bleach baths for atopic dermatitis: A systematic review and meta-analysis including unpublished data, Bayesian interpretation, and GRADE. Ann Allergy Asthma Immunol. 2022;128:660-668.e669 image Bleach baths for atopic dermatitis

Recommendations on bathing in the treatment of atopic dermatitis (AD) vary among pediatricians and specialists.  These recommendations may be 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.

Bleach Bathes have been considered with controversy related to effectiveness in meta-analysis showing minor improvement in patients with moderate to severe atopic dermatitis.

Elimination diets in atopic dermatitis are not recommended either with skin testing for foods or empiric due to minimal benefit and increased risk of developing IgE mediated food allergy by loss of oral tolerance due to avoidance without enteral exposure in patients with atopic dermatitis.