Moisturizing and bathing for eczema-prone skin

Moisturizing and gentle washing are the base of every eczema treatment plan. They help whatever type of eczema you have, but a doctor should confirm the diagnosis first, because other rashes need different care. This guide explains how to choose a moisturizer, how and when to apply it, and how to bathe without drying the skin, based on the NHS, the American Academy of Dermatology (AAD), the US National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and MedlinePlus. For the condition as a whole, see the complete guide to eczema. For babies and young children, ask the child's doctor for a bathing and moisturizing routine.

Why moisturizer matters so much

Eczema dries the skin from the inside. The AAD says eczema creates tiny cracks in the skin, so the skin loses water quickly. It says keeping skin well moisturized helps prevent cracks that could lead to a worse rash, itching or infection.

That is why moisturizer is a treatment in its own right. The NHS lists moisturizers, which it calls emollients, as one of the two main treatments for atopic eczema. The AAD's 2023 guideline for adults gives them a strong recommendation, saying they relieve dry, cracked skin, decrease inflammation, and reduce the severity of flare-ups and increase the time between them. NICE, the UK body that writes guidance for doctors, calls them the basis of eczema care for children, to be used even when the skin is clear. MedlinePlus says daily skin care may cut down on the need for medicines.

Choosing a moisturizer

The NHS describes four main kinds:

Kind	Feel	Good for
Ointment	Greasy, thick	Dry, thick skin and nighttime; not for weeping eczema
Cream	Less greasy, absorbs quickly	Daytime use
Lotion	Thin, spreads easily	Hairy areas and weeping eczema; less moisturizing
Spray	Absorbs quickly	Hard-to-reach areas and sore skin that should not be touched

Source: NHS, "Emollients."

The AAD recommends a mild, fragrance-free cream or ointment instead of a lotion for eczema. NIAMS says to use creams and ointments and avoid lotions with high water or alcohol content, which can cause burning. MedlinePlus advises products that do not contain alcohol, scents, dyes or other chemicals, and names petroleum jelly as an example of an ointment.

Some tips for reading labels:

• Choose "fragrance free." The AAD says fragrance can make atopic dermatitis flare. It warns that "unscented" means a fragrance has been covered up, and that it can still trigger a flare.
• Avoid aqueous cream. The NHS says aqueous cream is no longer recommended as a moisturizer, because it contains an ingredient that can cause burning, stinging, itching and redness.
• Expect some trial and error. The NHS says you may have to try a few moisturizers to find the best one, and that some people use a cream by day and an ointment at night.
• Test before you switch. The AAD suggests putting a small amount of a new product on the inside of your arm every day for 7 to 10 days, and using it only if your skin stays clear. The guide on how to patch test a new skincare product explains how.

How often to moisturize

The NHS atopic eczema page says to apply moisturizer as often as possible, and at least twice a day, and to keep going even when eczema improves. The NHS page on moisturizers suggests 3 or 4 times a day where possible, says they are safe and cannot be overused, and says to use them whenever the skin feels dry or tight. It says hands and face need moisturizer especially often, because they are the most exposed parts of the body. It also suggests keeping small pots at home, school or work.

How to apply it

The NHS gives clear steps:

1. Use a clean spoon or spatula to take moisturizer out of a pot, or use a pump. Do not put your fingers in the pot, because this can spread germs.
2. Smooth it gently onto the skin in the direction the hair grows. Do not rub it in. The NHS says this helps stop hair follicles getting blocked.
3. If you also use a steroid cream or other medicine, wait 20 to 30 minutes between the moisturizer and the medicine, and ask your doctor which one goes on first.
4. Do not share your moisturizer with anyone else.

How to bathe with eczema

Long soaks in water dry the skin. The steps below come from the AAD, NIAMS, MedlinePlus and the NHS:

1. Keep it short and warm. The AAD says a 5 to 10 minute bath or shower in warm water can help hydrate the skin, and that longer soaks can dry it. MedlinePlus says short, cooler baths are better than long, hot ones. NIAMS advises lukewarm baths, limited to once a day.
2. Skip ordinary soap. The NHS says everyday soaps, shampoos and shower gels usually dry out the skin and can make eczema worse, and advises washing with a moisturizer instead. To do this, mix a teaspoon of moisturizer with some warm water in your hand and spread it over the skin. NIAMS suggests a mild unscented bar soap or a non-soap cleanser as another option.
3. Avoid bubble baths. The NHS advises avoiding the irritating chemicals in bubble baths and shower gels.
4. Be gentle. MedlinePlus says not to scrub or dry the skin too hard or for too long.
5. Pat dry. NIAMS says to pat the skin dry after bathing and avoid rubbing.
6. Moisturize at once. The AAD says to apply moisturizer immediately after bathing, while the skin is still damp, to lock in moisture. The NHS says to apply it as soon as you have patted your skin dry.

Two safety points from the NHS: moisturizers make baths, showers and tiled floors slippery, so use a non-slip mat. And dressings, clothing and bedding that have soaked up moisturizer can catch fire more easily, so keep away from flames and cigarettes.

Bleach baths and other bath additives

A bleach bath is a medical treatment, and the amount matters. The AAD says adding a small amount of bleach to a bath may reduce bacteria and inflammation on the skin, and that you should only use this treatment if your dermatologist recommends it. NIAMS says not to use a bleach bath without first talking to your doctor, and to follow the doctor's instructions exactly. This guide gives no amounts, because the doctor sets them.

Other bath additives have limited proof. NICE advises doctors not to offer emollient bath additives to children with eczema, because a trial found they gave no extra benefit when families already washed with and applied leave-on moisturizers. NICE also says there is no evidence that taking fewer baths or showers, or using water softeners, helps eczema.

Moisturizing around other activities

The NHS suggests a few extra moments to moisturize. Some activities, such as gardening, can irritate the skin, and it may help to put on moisturizer before doing them. The NHS also suggests applying moisturizer before and after swimming, leaving enough time for it to soak in before you get in the water. MedlinePlus lists swimming often among the things that can dry out skin with atopic dermatitis, so moisturizing after a swim helps as well.

Keeping pots clean

Moisturizer pots can carry germs. The NHS says using a clean spoon or spatula to take moisturizer out of a pot reduces the risk of infection from a contaminated pot. NICE tells doctors to explain to families that after eczema has been infected, they should get new supplies of their skin treatments, because the old ones can become contaminated and cause infection again. Pumps and tubes avoid the problem, and the NHS suggests them as an alternative to dipping fingers into a pot.

Clothes, laundry and the home

Skin care goes beyond the bathroom. The AAD recommends loose-fitting 100 percent cotton clothing, never wearing wool next to the skin, fragrance-free and dye-free laundry detergent, washing new clothes before wearing them, and removing scratchy tags. MedlinePlus says a humidifier to keep home air moist can help. NIAMS suggests keeping your home at a cool, stable temperature and humidity. The guide to eczema flare-up triggers covers other everyday triggers.

When moisturizing is not enough

Many people need medicine as well as moisturizer. The NHS says a pharmacist can recommend treatments for small areas of dry, itchy eczema, and to see a doctor if eczema is more severe or treatments are not helping. The NHS says to talk to a doctor, nurse or pharmacist if a moisturizer causes burning or stinging that does not settle after a few days, blocked or inflamed hair follicles, or rashes on the face. The guide on how eczema is treated describes what a doctor may add, and eczema vs dry skin explains when dryness is a sign of something more.