Warning about baths and eczema - learn from my mistakes
I hope I save a parent and toddler from a lot of grief with my post. (And I don't mean to imply that baths cause eczema with my title...I will explain.) Based on my deep dives and desperate researching, I believe the most common perception is that eczema is genetic and attributable to a specific allergen or irritant that causes the eczema to surface. From our experience, I believe the reverse is also possible: that a LO with a perfectly healthy skin biome and immune system can develop eczema if the skin barrier is not properly protected - which then causes irritants (that would otherwise present no issue to a healthy skin) to inflame the skin, perpetuating the cycle.
For abbreviated background: We had a perfectly healthy, happy toddler with no skin issues until 16 months. It was an incredibly dry winter and she began to develop a red rash on her face, which morphed into small dry patches on her back and flexural areas...into what is now categorized as severe eczema all over her body up to her eyelids. I never appreciated how devastating eczema is to experience as a parent; the mental load of endless research, the guilt and anguish watching your LO suffer and be unable to help, simply seeing your child's perfect baby skin scabbed and bloodied, not to mention the physical exhaustion (applying the creams, endless laundry, oil everywhere, the doctors appointments, etc.). We thought we had done everything right. Since birth we used all unscented soaps, detergents, sensitive wipes, dressed her in all cotton clothing, introduced food allergens appropriately, had HEPA filters for the air, water filters on the bath, soap only a few times weekly, etc. We tested her for every allergy under the sun, positive that some allergen had flared her up, and nothing was flagged. We finally arrived at the conclusion that sometimes the simplest explanation truly is the right answer.
Every night since birth including through the dry winter I had mentioned, we were giving our toddler a hot bath. We did not wash with soap every night, but we had a water filter on the shower, and made it hot, steamy, with the shower pouring on her skin for 20 minutes every night (she had a few colds so this habit started when we were trying to create steam to provide her with congestion relief, and she seemed to enjoy it so we made a ritual of it). We also had electric heat (very drying) in some rooms of the home. The "baths" (more like showers) also became longer as she grew and increasingly enjoyed playing with toys in the bath. A few times I questioned my husband about the temperature of the water because her back would often be very red and her skin was hot to the touch, and we are of course kicking ourselves now, but because it became a ritual and she enjoyed it, we did not think much of it. I also felt instinctively that baths every night seemed excessive but dismissed it because almost any suggested toddler schedule has bath time built into it every evening: it was our ritual since birth. As I have fully come to appreciate through all my eczema research: the simplest skin biome is incredibly complex, with interactions between healthy fungi and bacteria maintaining an equilibrium. Once the skin barrier is weakened it is equally complex to rebuild it and in the interim, nearly anything can irritate it, leading to inflammation and flare ups.
Water/baths, especially when skin is already dry: I know that there is research showing that daily versus weekly showers did not make a difference in eczema patients but I maintain that even water (particularly, hot water while the skin is dry!) can strip the body of natural oils and upset the biome; I am referring to baths breaking down the skin barrier in the first place (not the effect it has after it has already been stripped). (Further, as an aside, public water lines, particularly in larger cities, also routinely flush the water with chlorine and other irritants to prevent bacteria. Check what is in your public water and use a water filter). Our first mistake was the daily, hot shower-baths. The second was ignoring the warning signs as her skin barrier began to break down. A NP at our pediatrician's office dismissed our LO's issue as "dry skin, very common in the winter" without even seeing her (based on one photo) and without discussing any background with us or probing about our habits. So we occasionally put Aquafore on her cheeks and some moisturizer on the dry spots on her back, waiting for the weather and humidity to improve. We did not have a moisturizing ritual that eczema maintenance requires or change any bath habits or other things in her environment even as her skin was warning us that it was breaking down.
Where we are now: I am happy to detail the long, sad journey and countless creams and solutions we looked to for the past several months if useful for anyone. I will summarize to say that I tried everything I could before turning to steroids (LO is under 2), but after months of flare ups, we have turned to them. The plan is to use a higher concentration of steroids for a short period of time to allow the skin barrier to repair. In terms of cream we are using La Roche Posay Triple Repair Moisturizer, which has been a game changer. So many other creams seemed to burn and inflame her skin (my best guess after drawing commonalities with all these creams is that it was due to the propylene glycol). The skin is making progress. It is very dry but no longer red and inflamed and the eczema seemed to have stopped spreading. LO stopped itching. Hopefully we will prevail and see her skin return. But still will forever be kicking ourselves that we ourselves systematically broke down our LO's healthy skin over time. Babies and toddlers' skin needs protection; listen to your instincts as a parent. If it feels extreme, don't do it. I will update.
EDIT/UPDATE: Because others are telling me that this information is helpful, I'm adding an update. We are on day 5 of the two-week, 2x/day topical steroid treatment (DermaSmoothe FS Oil + Mometasone cream for spots and flexural areas + La Roche Posay Triple Repair Cream for moisturizing) and LO's skin is entirely clear. We were instructed to continue with a short, warm bath (soap only 2x/week). We are also watching her intake of high histamine foods and being very conscious of how we dress her, particularly in heat.
- We stopped using her previous bath soap which was gentle but had a light fragrance for Cervae Baby Wash & Shampoo (NEA approved).
- Switched to Molly Suds from Dapple detergent and rid the house of Tide detergent that other members of the household was occasionally using. Interestingly I noticed a lot of soap residue/build up in the washer (including the blue, scented Tide) which I hadn't previously noticed, indicating it may have a drainage problem. LO's eczema was worse at her collar, back, and flexural areas where she has pores and the skin made heavier contact with clothing.
For clarity, I don't think either of those two things (the scented bath fragrance nor the laundry detergent) was causing the eczema (these were the same products we had been using since birth, and she did not start having skin issues until ~16 months). But, along with the moisturizers, could have been contributing to inflamed and irritated skin once her skin barrier was weakened and already inflamed. I'm hoping I can figure it out so her rash does not return after we stop the topical steroids - it was so bad!
***UPDATE 2, 3 weeks into steroid treatment: LO’s skin is entirely clear except her skin is so fragile that she does scratch easily and has difficulty healing with the steroids (trying to avoid scratched areas and put neosporn instead)! We are on the last week of Dermasmoothe Oil, now only 1x/day after the bath. (2 weeks 2x/day and now 2 weeks 1x/day which seems to coincide with what others on this chain said about not stopping the steroids immediately after skin clears). Continuing the daily bath with warm water to lock in moisture. Continuing to use La Roche Posay moisturizer. Cervae Baby Eczema soap and shampoo 1-2x per week (I don’t love this for LO’s hair which is so greasy from the oils but want to be safe). Weather temperature here has still been volatile but humidity has been high and consistent. We see a pediatric derm this week. Not sure if she can lend much insight since LO currently does not have any marks on her skin, but I’d like all the insights I can get to prevent this from happening again, and the continued need for steroids.