Bath time! (And skin care routine for eczema)

Skincare is an integral part of the treatment for eczema. Dryness of skin due to eczema occurs since the skin is unable to retain moisture. As far as my daughter is concerned, her skin care routine during bath and before sleeping at night usually takes up to an hour at times. I also moisturize her in between as many times as required depending on the weather and skin condition. She gets quite frustrated at times since it’s quite elaborate, but there is really no choice. For someone who such severely dry skin we have to take all precautions to prevent her skin from drying out.

Bath routine

The process that I follow is that of “moisturize and seal”. The skin is moistened during bath time and then followed immediately with sealing the moisture in. Also, I am very careful about the bath products that I use on her. I use only non scented, soap free cleansers on her skin . And if her skin has flared up a lot, I sometimes avoid applying anything on her skin at all apart from water or just sponge her gently. The bath is usually kept short to about 2-5 minutes to avoid further drying out of her skin. The steps that I take for her bath are as follows-

a short (2-5 min) bath that helps moisturize the skin
use some kind of emollient or bath oil/oatmeal powder in the water
use a soap free moisturizing cleanser on her
apply a thin layer of liquid paraffin to seal the moisturize (if required)
pat her skin dry (not rub)
apply moisturizer (ointment or cream depending on weather) as soon as possible before the skin becomes completely dry

Cleansing

Soap substitutes and bath emollients are very useful to clean and moisturize skin prone to eczema. I use bath emollients like Hydromol/ Oilatum bath emollient or oatmeal powder to add to her bath water to provide additional moisture to her skin.

Based mostly on the experiences of other parents across the world (through their blogs and other interactions over the years) I completely avoid bath and skincare products which have Sulphates in them and Sodium lauryl sulphate (SLS) in particular. Some studies have shown that Sulphates and SLS in particular can damage the skin barrier in people with healthy skin as well. (Source: http://www.eczema.org/aqeous; http://www.ncbi.nlm.nih.gov/pubmed/14728695)

SLS is a synthetic detergent (cleaning agent) and surfactant (which means it makes bubbles). It is used in industrial products such as car wash soap, engine degreasers and floor cleaners. But it is also used in a wide range of personal care products such as soaps, shampoos and toothpastes to create lather. While it is known to irritate skin when it comes into contact with products which have high doses of SLS, it can also damage skin of children with Atopic Dermatits. Usually, regular baby bath products contain Sodium Laureth Sulphate (SLES) which is gentler than SLS and is used to produce foam.

Last year when Aiyana’s skin condition was not improving at all was the time I decided to cut out this group altogether. I found options like Calfornia Baby products which are not only free of SLS and SLES but are also free of preservatives like Parabens. Instead they use coconut derived amino acids in their lotions which act as preservatives but are actually antioxidants; gluconolactone (corn) (and) sodium benzoate, an approved preservative for organic products in their shampoos and body washes. I am sure there are other such products which are equally gentle on the skin but as of now I am sticking to this range since I really do not want to take any chances with her skin care. It has proven to be gentle enough to be used even when her skin was not in a very good condition.

Oilatum Bath Additive Oil

There are other less expensive options which I have used for Aiyana like Aveeno bath products (for e.g. Aveeno Skin Relief Body Wash); Oilatum bath emollient; Hydromol bath emollient and E45 cream and emollient. These have also worked well for her in the past and I still use a few of them (like Oilatum and E45) off and on both my children depending on their availability and skin condition. The paraffin based bath oils and creamy washes are good options in the summer months in a humid climate in our country. I have used the ointment form for cleansing (Epaderm and Hydromol ointments which are emollients and cleansers- all in one) a few times for my daughter when her skin had become extremely dry during the winter months. But I suppose for most children the bath oils and creamy washes should do the trick.

Products

Aveeno body wash is an oat based creamy wash;
Hydromol bath and shower emollient and Oilatum bath additive emollients are both liquid paraffin based bath oils (they also have cream based washes)
E45 has a cream wash and an emollient bath oil which work as a cleanser; Epaderm is in the form of a 3 in 1 emollient, bath additive and skin cleanser in ointment form
There are also other bath additives and creamy cleansers from Cetaphil, QV, Eucerin, Neosporin Ecema Essentials amongs others
Epaderm 3 in 1 ointment

Availability

Aveeno products are usually available in Mumbai based stores like Just Moms (Breach Candy), Green Bell (Juhu), Amarsons. They can also be bought online from amazon.co.uk or amazom.com and a few sellers do ship them to India
Oilatum is readily available in most big chemist shops
Cetaphil, Eucerin and E45 are sometimes available in the same shops I have mentioned above
Hydromol and Epaderm is available in the UK and I buy online from amazon.co.uk or request my friends to get it for me
QV and other brands like Neosporin are available in the US and can be bought online through amazon.com but are not shipped by all sellers ( I am trying to figure out a way to get Neosporin Eczema Essentials Products for Aiyana since they are being recommended by quite a few parents)

Moisturizing routine

Emollients are found in various forms like creams, lotions and oils and are essentially used to moisturize dry skin. I have already mentioned in details the moisturizing routine in my earlier post “Moisturizers and Eczema”. There are many products from brands like Exomega, Cetaphil, Avene, Hope’s Relief Cream. I have tried various products at different points in time depending on her skin condition and availability.

But the most important thing is to quickly seal in the moisture after bath while the skin is still moist after being patted dry. Also, when the weather is hot and moist (mostly the case in Mumbai), I go lighter, meaning I use creams and lotions (if it’s very hot and humid lotions work well during the day); when it’s cool and dry I go heavier, meaning I use ointments or creams to provide better moisturization for my daughter.

I hope this article helps in giving you some basic pointers on the skin care routine that is so necessary for children (or even adults) with eczema to keep their skin healthy and their lives as normal and comfortable as possible. Please feel free to share your experiences and write to me with your questions if any!