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Does daily bathing or showering worsen atopic dermatitis severity? A systematic review and meta-analysis

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Abstract

The optimal frequency of water bathing/showering in atopic dermatitis (AD) is unknown. We sought to determine the efficacy of different bathing/showering frequencies at improving AD severity. A systematic review and meta-analysis was performed of studies evaluating the clinical efficacy of bathing/showering regimen in AD. MEDLINE, EMBASE, SCOPUS, LILACS, Cochrane, China National Knowledge Infrastructure, Taiwan electronic periodical services and CiNii were searched. Two authors independently performed title/abstract and full-text review and data extraction. All 13 included studies were prospective and demonstrated numerically reduced AD severity in patients treated with a water bathing/showering regimen in ≥ 1 time-point compared with baseline. In random-effects regression models, baths/showers ≥ 7 vs. < 7 times per week were not associated with significant differences of Cohen’s D scores for eczema area and severity index (n = 5 studies; least-square means: 1.34 vs. 0.90; P = 0.45; I2 = 91.8), Scoring AD (n = 5 studies; 0.73 vs. 0.41; P = 0.13; I2 = 97.4) or body surface area (n = 4 studies; 0.45 vs. 0.28; P = 0.17; I2 = 93.4). Similar results were observed in sensitivity analyses by study design, quality, use of emollients, and use of topical corticosteroids. No publication bias was detected by Egger regression (P ≥ 0.26) or Begg rank (P ≥ 0.19) tests. Three studies were included in the qualitative analysis, which found that bathing/showering ≥ 7 resulted in significant improvement of Investigator Global Assessments, extent of skin lesions and itch caused by AD. In conclusion, the optimal frequency of water bathing/showering in AD remains unclear. Daily showers/baths were not associated with worse severity, and should be permitted in AD. Larger scale, well-designed RCT are still needed to determine the optimal bathing parameters.

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Abbreviations

OR:

Odds ratio

CI:

Confidence interval

AD:

Atopic dermatitis

TCS:

Topical corticosteroid

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Authors and Affiliations

  1. Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA

    Tammy Hua, Muhammad Yousaf, Eran Gwillim, Brad Lee, Taylor Erickson & Brian Cheng

  2. National Skin Centre, Singapore, Singapore

    Yik Weng Yew

  3. Kansas City University of Medicine and Biosciences, Kansas City, MO, 64106, USA

    Kevin Hua

  4. Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Suite 2B-425, 2150 Pennsylvania Ave NW, Washington, DC, 20037, USA

    Jonathan I. Silverberg

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  1. Tammy Hua
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  2. Muhammad Yousaf
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Contributions

JS had full access to all the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis. Study concept and design: JS. Acquisition of data: JS, HT, YM, GE, YY, LB, HK, ET, and CB. Analysis and interpretation of data: JS, HT, YM, GE, YY, LB, HK, ET, and CB. Drafting of the manuscript: HT and JS. Critical revision of the manuscript for important intellectual content: JS, HT, YM, GE, YY, LB, HK, ET, and CB. Statistical analysis: JS and HT. Obtained funding: none. Administrative technical or material support: none. Study supervision: none.

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Correspondence to Jonathan I. Silverberg.

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Hua, T., Yousaf, M., Gwillim, E. et al. Does daily bathing or showering worsen atopic dermatitis severity? A systematic review and meta-analysis. Arch Dermatol Res 313, 729–735 (2021). https://doi.org/10.1007/s00403-020-02164-0

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