Eczema: Daily 'soak and smear' or steer clear?

A new article in Annals of Allergy, Asthma and Immunology, the scientific publication of the American College of Allergy, Asthma and Immunology (ACAAI) looks at the research and answers the question. According to the authors, daily bathing is fine, as long as it's followed by lots of moisturizer. In other words, "soak and smear."

"A number of medical groups have commented on the general role of bathing in eczema," says allergist Ivan D. Cardona, MD, lead author of the paper and ACAAI member. "But they don't all agree on the best bathing practices. Specifically, many groups don't comment on bathing frequency. Because parents are confused, and because they often take their questions to their allergist, we wanted to examine the studies that have been published on the topic, and see if there was agreement on just how often children with eczema should be bathed."

Eczema involves extremely dry skin, and some medical professionals think infrequent bathing (defined in this paper as less than once a day) is the best way to avoid irritating the skin. They believe infrequent bathing helps keep skin hydrated because it avoids constant evaporation of water, which can be drying. Infrequent bathing also means less use of the soaps which can aggravate eczema.

Those in favor of frequent bathing (defined in the paper as at least once a day) believe the presence of very dry skin requires hydration with daily baths followed by moisturizer. Limited use of pH balanced skin cleansers should also be part of frequent bathing, along with gentle patting dry, and the immediate application of a moisturizer to "seal" in moisture. This process is known as "soak and smear."

"The smear part is really the most important element, because unless moisturizer is applied immediately, then the skin is likely to dry out even more," says allergist Neal Jain, MD, ACAAI Fellow and co-author of the paper. "The weight of the evidence in the literature we reviewed and our experience in caring for these patients suggests daily bathing with 'soak and smear' is more effective for soothing dry skin from eczema."