Optimal bathing frequency and duration in pediatric atopic dermatitis

Bathing practices are commented on in the 2017 comparison of the Joint Task Force Practice Parameter and American Academy of Dermatology guidelines.

They note that recommendations for bathing practices largely stem from expert consensus, with few objective measures documented in the literature. They recommend bathing with warm water, followed by application of moisturizers. They note an appropriate bathing duration of at least 10 minutes but did not recommend a specific frequency.

Eichenfield LF, Ahluwalia J, Waldman A, Borok J, Udkoff J, Boguniewicz M. Current guidelines for the evaluation and management of atopic dermatitis: A comparison of the Joint Task Force Practice Parameter and American Academy of Dermatology guidelines. J Allergy Clin Immunol. 2017 Apr;139(4S):S49-S57.

This question of bathing frequency and duration was not specifically addressed in the 2023 atopic dermatitis guidelines, though they did suggest bleach baths for patients with moderate-to severe atopic dermatitis as an additive therapy and suggest against bleach baths for those with mild atopic dermatitis.

AAAAI/ACAAI JTF Atopic Dermatitis Guideline Panel; Chu DK, Schneider L, Asiniwasis RN, et aL. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations. Ann Allergy Asthma Immunol. 2024 Mar;132(3):274-312.

Cardona and coworkers reported on a randomized clinical trial of twice-daily soaking baths for 10 to 15 minutes, followed by immediate application of an occlusive moisturizer (soak-and-seal), versus twice-weekly soak-and-seal baths for 10 minutes or less. The more frequent longer baths were associated with better outcomes.

Cardona ID, Kempe EE, Lary C, Ginder JH, Jain N. Frequent Versus Infrequent Bathing in Pediatric Atopic Dermatitis: A Randomized Clinical Trial. J Allergy Clin Immunol Pract. 2020 Mar;8(3):1014-1021.

Eric Macy, MD, MS, FAAAAI