Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
Archives of Dermatological Research Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

OR:

Odds ratio

CI:

Confidence interval

AD:

Atopic dermatitis

TCS:

Topical corticosteroid

References

  1. Karimkhani C, Dellavalle RP, Coffeng LE et al (2017) Global skin disease morbidity and mortality: an update from the global burden of disease study 2013. JAMA Dermatol 153(5):406–412

    Article  PubMed  PubMed Central  Google Scholar 

  2. Cheng BT, Silverberg JI (2020) Association between atopic dermatitis and lower health utility scores in US adults. Ann Allergy Asthma Immunol Off Pub Am College 124(1):88–89

    Article  Google Scholar 

  3. Silverberg JI, Gelfand JM, Margolis DJ et al (2019a) Health utility scores of atopic dermatitis in US adults. J Allergy Clin Immunol Pract 7(4):1246–1252

    Article  PubMed  Google Scholar 

  4. Yew YW, Thyssen JP, Silverberg JI (2019) A systematic review and meta-analysis of the regional and age-related differences in atopic dermatitis clinical characteristics. J Am Acad Dermatol 80(2):390–401

    Article  PubMed  Google Scholar 

  5. Silverberg JI, Margolis DJ, Boguniewicz M et al (2019) Distribution of atopic dermatitis lesions in United States adults. J Eur Acad Dermatol Venereol JEADV 33(7):1341–1348

    Article  CAS  PubMed  Google Scholar 

  6. Lee HH, Patel KR, Singam V, Rastogi S, Silverberg JI (2019) A systematic review and meta-analysis of the prevalence and phenotype of adult-onset atopic dermatitis. J Eur Acad Dermatol Venereol JEADV 80(6):1526–1532

    Google Scholar 

  7. Silverberg JI, Vakharia PP, Chopra R et al (2018) Phenotypical differences of childhood- and adult-onset atopic dermatitis. J Eur Acad Dermatol Venereol JEADV 6(4):1306–1312

    Google Scholar 

  8. Silverberg JI, Lei D, Yousaf M et al (2020a) Association of itch triggers with atopic dermatitis severity and course in adults. Ann Pub Am College Allergy Asthma Immunol 1:6

    Google Scholar 

  9. Kantor R, Silverberg JI (2017) Environmental risk factors and their role in the management of atopic dermatitis. Expert Rev Clin Immunol 13(1):15–26

    Article  CAS  PubMed  Google Scholar 

  10. Narla S, Silverberg JI (2020) The role of environmental exposures in atopic dermatitis. Current Allergy Asthma Rep 20(12):74

    Article  Google Scholar 

  11. Kathuria P, Silverberg JI (2016) Association of pollution and climate with atopic eczema in US children. Pediatr Allergy Immunol Off Pub Eur Soc 27(5):478–485

    Article  CAS  Google Scholar 

  12. Silverberg JI, Hanifin J, Simpson EL (2013) Climatic factors are associated with childhood eczema prevalence in the United States. J Invest Dermatol 133(7):1752–1759

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Kim JP, Chao LX, Simpson EL, Silverberg JI (2016) Persistence of atopic dermatitis (AD): a systematic review and meta-analysis. J Am Acad Dermatol 75(4):681–687

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hong MR, Lei D, Yousaf M et al (2020) A real-world study of the longitudinal course of adult atopic dermatitis severity in clinical practice. Ann Allergy Asthma Immunol Off Pub Am College 1:9

    Google Scholar 

  15. McKenzie C, Silverberg JI (2019) The prevalence and persistence of atopic dermatitis in urban United States children. Ann Allergy Asthma Immunol Off Pub Am College 123(2):173–178

    Article  Google Scholar 

  16. Vakharia PP, Chopra R, Sacotte R et al (2017) Burden of skin pain in atopic dermatitis. Ann Allergy Asthma Immunol Off Pub Am College 119(6):548–552543

    Article  Google Scholar 

  17. Fishbein AB, Vitaterna O, Haugh IM et al (2015) Nocturnal eczema: review of sleep and circadian rhythms in children with atopic dermatitis and future research directions. J Allergy Clin Immunol 136(5):1170–1177

    Article  PubMed  Google Scholar 

  18. Silverberg JI, Garg NK, Paller AS, Fishbein AB, Zee PC (2015) Sleep disturbances in adults with eczema are associated with impaired overall health: a US population-based study. J Invest Dermatol 135(1):56–66

    Article  CAS  PubMed  Google Scholar 

  19. Yu SH, Attarian H, Zee P, Silverberg JI (2016) Burden of sleep and fatigue in US adults with atopic dermatitis: contact, atopic, occupational, drug: official journal of the American Contact Dermatitis Society, North American Contact. Dermatitis 27(2):50–58

    Article  PubMed  Google Scholar 

  20. Cheng BT, Silverberg JI (2019) Depression and psychological distress in US adults with atopic dermatitis. Ann Allergy Asthma Immunol Off Pub Am College 123(2):179–185

    Article  Google Scholar 

  21. Patel KR, Lee HH, Rastogi S et al (2020) Association between hidradenitis suppurativa, depression, anxiety, and suicidality: a systematic review and meta-analysis. J Am Acad Dermatol 83(3):737–744

    Article  PubMed  Google Scholar 

  22. Silverberg JI, Gelfand JM, Margolis DJ et al (2019b) Symptoms and diagnosis of anxiety and depression in atopic dermatitis in US adults. Br J Dermatol 181(3):554–565

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Silverberg JI, Lei D, Yousaf M et al (2020b) Association of atopic dermatitis severity with cognitive function in adults. J Am Acad Dermatol 1:6–12

    Google Scholar 

  24. Silverberg JI, Gelfand JM, Margolis DJ et al (2018) Patient burden and quality of life in atopic dermatitis in US adults: A population-based cross-sectional study. Ann Allergy Asthma Immunol Off Pub Am College 121(3):340–347

    Article  Google Scholar 

  25. Boguniewicz M, Fonacier L, Guttman-Yassky E, Ong PY, Silverberg J, Farrar JR (2018) Atopic dermatitis yardstick: practical recommendations for an evolving therapeutic landscape. Ann Allergy Asthma Immunol Off Pub Am College 120(1):10–2212

    Article  Google Scholar 

  26. Singh P, Silverberg JI (2019) Outpatient utilization patterns for atopic dermatitis in the United States. J Am Acad Dermatol 5:12–34

    Google Scholar 

  27. Galli E, Neri I, Ricci G et al (2016) Consensus conference on clinical management of pediatric atopic dermatitis. Ital J Pediat 42(1):26

    Article  Google Scholar 

  28. Chopra R, Vakharia PP, Sacotte R, Silverberg JI (2017) Efficacy of bleach baths in reducing severity of atopic dermatitis: A systematic review and meta-analysis. Ann Allergy Asthma Immunol Off Pub Am College 119(5):435–440

    Article  Google Scholar 

  29. Totté JEE, van der Feltz WT, Hennekam M, van Belkum A, van Zuuren EJ, Pasmans SGMA (2016) Prevalence and odds of Staphylococcus aureus carriage in atopic dermatitis: a systematic review and meta-analysis. Br J Dermatol 175(4):687–695

    Article  PubMed  Google Scholar 

  30. Women’s NCCf Health Cs (2007) Atopic eczema in children: management of atopic eczema in children from birth up to the age of 12 years. RCOG Press, Cambridge

    Google Scholar 

  31. Schneider L, Tilles S, Lio P et al (2013) Atopic dermatitis: a practice parameter update 2012. J Allergy Clin Immunol 131(2):295–299

    Article  PubMed  Google Scholar 

  32. Ring J, Alomar A, Bieber T et al (2012) Guidelines for treatment of atopic eczema (atopic dermatitis) part I. J Eur Acad Dermatol Venereol 26(8):1045–1060

    Article  CAS  PubMed  Google Scholar 

  33. Sinclair W, Aboobaker J, Jordaan F, Modi D, Todd G (2008) Management of atopic dermatitis in adolescents and adults in South Africa. SAMJ South African Med J 98:303

    CAS  Google Scholar 

  34. Cardona ID, Kempe E, Hatzenbeuhler JR, Antaya RJ, Cohen B, Jain N (2015) Bathing frequency recommendations for children with atopic dermatitis: results of three observational pilot surveys. Pediatr Dermatol 32(4):e194-196

    Article  PubMed  Google Scholar 

  35. Kempe E, Jain N, Cardona I (2013) Bathing frequency recommendations for pediatric atopic dermatitis: are we adding to parental frustration? Ann Allergy Asthma Immunol 111(4):298–299

    Article  PubMed  Google Scholar 

  36. Nankervis H, Pynn EV, Boyle RJ et al (2015) House dust mite reduction and avoidance measures for treating eczema. Cochrane Database Syst Rev 1:9

    Google Scholar 

  37. Wells GA, Shea B, O’’Connell D et al (2000) The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analysis

  38. Modesti PA, Reboldi G, Cappuccio FP et al (2016) Panethnic differences in blood pressure in Europe: a systematic review and meta-analysis. PLoS ONE 11(1):e0147601

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  39. Sterne JAC, Savovic J, Page MJ et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:l4898

    Article  PubMed  Google Scholar 

  40. Gonzalez ME, Schaffer JV, Orlow SJ et al (2016a) Cutaneous microbiome effects of fluticasone propionate cream and adjunctive bleach baths in childhood atopic dermatitis. J Am Acade Dermatol 75(3):481–493488

    Article  CAS  Google Scholar 

  41. Hon KL, Tsang YC, Lee VW et al (2016a) Efficacy of sodium hypochlorite (bleach) baths to reduce Staphylococcus aureus colonization in childhood onset moderate-to-severe eczema: a randomized, placebo-controlled cross-over trial. J Dermatol Treat 27(2):156–162

    Article  CAS  Google Scholar 

  42. Huang JT, Abrams M, Tlougan B, Rademaker A, Paller AS (2009) Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity. Pediatrics 123(5):e808-814

    Article  PubMed  Google Scholar 

  43. Kim H, Ban J, Park MR et al (2012) Effect of bathing on atopic dermatitis during the summer season. Asia Pac Allergy 2(4):269–274

    Article  PubMed  PubMed Central  Google Scholar 

  44. Kohn LL, Kang Y, Antaya RJ (2016) A randomized, controlled trial comparing topical steroid application to wet versus dry skin in children with atopic dermatitis (AD). J Am Acad Dermatol 75(2):306–311

    Article  CAS  PubMed  Google Scholar 

  45. Koutroulis I, Petrova K, Kratimenos P, Gaughan J (2014) Frequency of bathing in the management of atopic dermatitis: to bathe or not to bathe? Clin Pediatr (Phila) 53(7):677–681

    Article  Google Scholar 

  46. Mochizuki H, Muramatsu R, Tadaki H, Mizuno T, Arakawa H, Morikawa A (2009) Effects of skin care with shower therapy on children with atopic dermatitis in elementary schools. Pediatr Dermatol 26(2):223–225

    Article  PubMed  Google Scholar 

  47. Murota H, Takahashi A, Nishioka M et al (2010) Showering reduces atopic dermatitis in elementary school students. Eur J Dermatol 20(3):410–411

    Article  PubMed  Google Scholar 

  48. White M, Batten T, Ormerod A (1994) Adverse effects of a daily bathing routine on children with atopic dermatitis. J Dermatol Treat 5(1):21–23

    Article  Google Scholar 

  49. 亀好良一, 田中稔彦, 望月満, et al. アトピー性皮膚炎に対する学校でのシャワー浴の効果. アレルギー. 2008;57(2):130–137.

  50. Hajar T, Hanifin JM, Tofte SJ, Simpson EL (2014a) Pre-hydration is effective for rapid control of recalcitrant atopic dermatitis. Dermatitis Contact Atopic Occupat Drug 25(2):56

    CAS  Google Scholar 

  51. Wong SM, Ng TG, Baba R (2013) Efficacy and safety of sodium hypochlorite (bleach) baths in patients with moderate to severe atopic dermatitis in Malaysia. J Dermatol 40(11):874–880

    Article  CAS  PubMed  Google Scholar 

  52. Rustad K, Henning S (2009) Direct observed “soak and smear” therapy for severe eczematous dermatitis in the combat setting Dermatitis : contact, atopic, occupational, drug : official journal of the American Contact Dermatitis Society, North American Contact Dermatitis. Dermatitis 20(5):275–277

    Article  PubMed  Google Scholar 

  53. Eichenfield LF, Tom WL, Berger TG et al (2014a) Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol 71(1):116–132

    Article  PubMed  PubMed Central  Google Scholar 

  54. Eichenfield LF, Tom WL, Berger TG et al (2014b) Guidelines of care for the management of atopic dermatitis. J Am Acad Dermatol 71(1):116

    Article  PubMed  PubMed Central  Google Scholar 

  55. Sarre ME, Martin L, Moote W, Mazza JA, Annweiler C (2015) Are baths desirable in atopic dermatitis? J Eur Acad Dermatol Venereol JEADV 29(7):1265–1274

    Article  PubMed  Google Scholar 

  56. Lynde C, Barber K, Claveau J et al (2005) Canadian practical guide for the treatment and management of atopic dermatitis. J Cutan Med Surg 8(Suppl 5):1–9

    PubMed  Google Scholar 

  57. Hajar T, Hanifin JM, Tofte SJ, Simpson EL (2014b) Prehydration is effective for rapid control of recalcitrant atopic dermatitis Dermatitis : contact, atopic, occupational, drug : official journal of the American Contact Dermatitis Society, North American Contact Dermatitis Group. Dermatitis 25(2):56–59

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Gutman AB, Kligman AM, Sciacca J, James WD (2005) Soak and smear: a standard technique revisited. Arch Dermatol 141(12):1556–1559

    Article  PubMed  Google Scholar 

  59. Schaefer H, Zesch A (1982) Stüttgen Gn Skin permeability. Springer, Berlin, New York

    Book  Google Scholar 

  60. Rothman S (1954) Physiology and biochemistry of the skin. University of Chicago Press, Chicago

    Google Scholar 

  61. Hon KL, Tsang YC, Lee VW et al (2016b) Efficacy of sodium hypochlorite (bleach) baths to reduce Staphylococcus aureus colonization in childhood onset moderate-to-severe eczema: a randomized, placebo-controlled cross-over trial. J Dermatol Treatment 27(2):156–162

    Article  CAS  Google Scholar 

  62. Gonzalez ME, Schaffer JV, Orlow SJ et al (2016b) Cutaneous microbiome effects of fluticasone propionate cream and adjunctive bleach baths in childhood atopic dermatitis. J Am Acad Dermatol 75(3):481-493.e488

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

None.

Author information

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

Authors
  1. Tammy Hua
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Muhammad Yousaf
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eran Gwillim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yik Weng Yew
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Brad Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kevin Hua
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Taylor Erickson
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Brian Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jonathan I. Silverberg
    View author publications

    You can also search for this author in PubMed Google Scholar

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.

Corresponding author

Correspondence to Jonathan I. Silverberg.

Ethics declarations

Conflict of interest

None declared.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 22 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00403-020-02164-0

Keywords

Search

Navigation