Are baths desirable in atopic dermatitis?

Bathing is a therapeutic measure commonly advised in atopic dermatitis (AD). Whether baths improve skin condition remains yet unclear. Our objectives were to appreciate the effect of 1-month tap water bathing on the submerged skin of AD patients, and to evaluate the proportion of AD patients in favour of baths.

A Medline search of the last 30 years was performed in November 2012 using the Medical Subject Heading terms 'Atopic Dermatitis' OR 'Eczema' combined with 'Baths' OR 'Bath' OR 'Hydrotherapy' OR 'Cleansing' OR 'Soak'. Interventional studies measuring skin changes after tap water bathing were selected for the first analysis. Observational studies reporting the proportion of AD patients favourable to baths were selected for the second analysis. Important details regarding methods and results were independently extracted by two authors. Random-effects models were used to combine data on outcomes and conduct meta-analyses.

Of the 271 abstracts initially identified, seven studies met the selection criteria. All were of good quality. The number of patients with AD ranged from 89 to 260 (41.4-66.3% female). The pooled effect size of skin changes after baths was -0.10 (95% confidence interval: -0.47 to 0.28) in random-effects meta-analysis. The meta-analytical pooled proportion of AD patients in favour of baths was 29.1% (18.5-42.7).

We found no evidence of an effect of 1-month tap water bathing on skin changes in AD. Only 29 percent of AD patients were favourable to baths. Use of baths in AD should be decided together with the patient.