Updated: 04/12/2021

SUMMARY:

Written by Board-Certified Dermatologist, Dr. Rina Allawh

Have you been struggling with finding the right hygiene routine? We gathered dermatologist tips and recommendations for finding a skincare routine that will help manage dry skin and eczema and help prevent flare ups from recurring.

WHY IS BATHING AND CLEANSING ECZEMA-PRONE SKIN IMPORTANT?

Proper bathing and cleansing eczema-prone skin is key to managing one’s eczema and helping to prevent flares. In eczema, the skin’s protective barrier, also referred to as, the epidermis, is impaired¹. This impaired epidermal barrier causes increased water loss from the skin, increased risk for bacterial, fungal and viral skin infections and allergic reactions from chemicals and pollutants in the environment1. While bathing can be a disruptive to the skin barrier, it is essential in maintaining proper hygiene. The key is to bathe gently to maintain the skin's protective barriers to help prevent infection.

RECOMMENDED ROUTINE FOR DRY TO EXTRA DRY SKIN & ECZEMA

Gentle cleansers and eczema cleansers are essential to help maintain the protective skin barrier and moisture in dry to extra dry skin and eczema-prone skin.

Searching for “skin-safe” products to implement in your daily routine for eczema and dry skin may be a daunting task. Here are a few tips when searching for washes, cleansers, moisturizers, and sunscreens.

1. Soaps and cleansers: Start your day with a gentle cleanser when washing your face and body. Avoid harsh soaps and exfoliants as these may be irritating and worsen dry skin and eczema. Eczema cleansers containing hydrating ingredients, such as shea butter and glycerin ceramides and hyaluronic acid, provide that extra boost of hydration needed to help maintain skin moisture and integrity of the protective skin barrier. Avoid eczema cleansers and exfoliants with harsh ingredients, as these may be irritating and worsen dry skin and eczema.

2. Moisturizers: Moisturizing after cleansing is a key step to maintaining skin hydration. Moisturizers containing hydrating ingredients such as hyaluronic acid, shea butter, and glycerin or barrier reinforcing ingredients such as niacinamide or ceramides are recommended when treating dry to extra dry skin. The texture of the moisturizer may play an important role as well. For example, thick creams and ointments can be especially helpful in sealing in moisture to the skin barrier.

3. Sunscreens: When searching for a sunscreen, it is important to look for an SPF above 30 with ingredients that are potentially non-irritating and hydrating. Look for mineral sunscreens that contain zinc oxide or titanium dioxide, both of which are ingredients safe to use on the face and body and provide broad coverage against UVB and UVA. Sunscreen lotions and moisturizers are favored over sprays in individuals with dry, sensitive skin and/or eczema.

INGREDIENTS TO LOOK FOR IN DRY SKIN & ECZEMA CLEANSERS

• Niacinamide: Niacinamide is an effective barrier-repair ingredient that is known to increase the production of essential lipids (ceramides) and proteins (fillagrin) in the epidermis². The integrity of skin proteins and lipids is frequently impaired in individuals with eczema and dry skin. Niacinamide also has anti-inflammatory properties and may help to reduce skin redness².


• Glycerin: Glycerin is a humectant, a moisturizing ingredient that draws water into the outer layer of the skin and helps reduce further water loss². Glycerin is frequently added to cleansers and eczema cleansers to counter their drying effects on the skin.


• Ceramides: Ceramides are lipids that are found in the top layer of the skin, also referred to as the stratum corneum². Ceramides are an essential ingredient for helping to protect the skin barrier and preventing skin water loss².


• Shea butter: Shea butter, derived from the shea tree fruit (Butyrospermum parkii), is rich in lipids and is frequently included in cleansers for its hydrating properties².


• Prebiotics: The Skin microbiome continues to be evaluated for its role in eczema and overall skin health. Studies have revealed that individuals with eczema are more likely to have an imbalanced skin microbiome in which harmful microorganisms dominate³. The use of prebiotic ingredients to promote the growth of healthy bacteria in order to re-balance the skin microbiome has been evaluated with promising results^{3 4}.

INGREDIENTS TO AVOID IN DRY SKIN & ECZEMA CLEANSERS:

• Drying Alcohols: Denatured ethyl alcohol is commonly used in cosmetic formulations to help dissolve other ingredients and provide freshness. This type of alcohol is also an antimicrobial ingredient; however, it may be irritating and drying to the skin⁶.


• Fragrance: Fragrance is frequently added to body washes and cleansers to make them smell pleasant or mask the natural odors of other ingredients. However, it can cause skin reactions for some, which may worsen dry and eczema-prone skin.


• Propylene Glycol:Propylene glycol is a colorless, odorless liquid used in various hygiene products. Propylene glycol can function as a stabilizer, thickener, or solubility enhancer for other ingredients⁶. Despite its favorable qualities, propylene glycol may cause skin irritation or eczema-like skin reactions⁶.


• Artificial Colorants:Artificial colorants and dyes are common skin irritants and may cause skin allergic reactions with repeated exposure⁶. If you experience any skin reactions from the ingredients mentioned above, speak with your dermatologist about skin testing for potential contact allergies.

DERMATOLOGIST TIPS FOR BATHING AND CLEANSING ECZEMA & DRY SKIN

1. Avoid harsh cleansers and exfoliants. Gentle cleansers and eczema cleansers are recommended as they can be less drying and irritating to eczema prone skin.

2. Use lukewarm water. Avoid use of hot water in baths or showers as this can further dry out skin and lead to more skin water loss. Hot water can strip away natural oils from the skin and has been shown to worsen skin redness and inflammation.

3. Avoid use of loofah, body puff, or washcloth. These tools may be irritating to the skin and harbor bacteria, worsening dry skin and eczema.

4. Pat dry, don’t rub.void rubbing with the towel as the friction may worsen dry skin and redness, but also may worsen itching on eczema patches. There is a frictional component to eczema, meaning scrubbing and rubbing of the skin may induce new eczema patches and worsen itching.

5. Limit bathing, if possible.Cleansing is important to prevent skin infection; however, frequent showers may worsen dry skin and eczema. If you take more than one shower a day, it is important to limit time and exposure to soap and water.

6. Avoid bubble baths.Though bubble baths may feel soothing in the moment, bubble baths can further dry out the skin and worsen itching.

7. Keep showers brief. Limit showers to five to ten minutes, especially for those managing eczema or have eczema-prone skin.

8. Moisturize after bathing or showering After each bath or shower, it is important to apply a thick moisturizer to damp skin to hasten absorption of the moisturizer. Moisturizers not only help to lock in skin moisture, but can also help with itching, skin inflammation, and redness.

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References

1. Gittler, Julia K., Jason F. Wang, and Seth J. Orlow. "Bathing and associated treatments in atopic dermatitis." American journal of clinical dermatology 18.1 (2017): 45-57.
2. Del Rosso, James Q. "Repair and maintenance of the epidermal barrier in patients diagnosed with atopic dermatitis: an evaluation of the components of a body wash-moisturizer skin care regimen directed at management of atopic skin." The Journal of Clinical and Aesthetic Dermatology 4.6 (2011): 45.
3. Schettle, Lidia. "Probiotics: The Search for Bacterial Balance.”
4. Weston, Stephanie, et al. "Effects of probiotics on atopic dermatitis: a randomised controlled trial." Archives of disease in childhood 90.9 (2005): 892-897.
5. Törmä, Hans, Magnus Lindberg, and Berit Berne. "Skin barrier disruption by sodium lauryl sulfate-exposure alters the expressions of involucrin, transglutaminase 1, profilaggrin, and kallikreins during the repair phase in human skin in vivo." Journal of investigative dermatology 128.5 (2008): 1212-1219.
6. Tan, Cher-Han, Sarah Rasool, and Graham A. Johnston. "Contact dermatitis: allergic and irritant." Clinics in dermatology 32.1 (2014): 116-124