Frequent Versus Infrequent Bathing in Pediatric Atopic Dermatitis: A Randomized Clinical Trial

To examine the relationship between bathing frequency and disease severity in pediatric atopic dermatitis (AD).

The study included 42 children aged 6 months to 11 years with moderate-to-severe AD.

The authors conducted a 1:1 randomized, single-blind, crossover trial over a two-week period comparing twice-daily soak-and-seal bathing 15 to 20 minutes (“wet method”) with twice-weekly soak-and-seal bathing less than 10 minutes (“dry method”). Patients received the same treatment of a moisturizer, cleanser, and low-potency topical corticosteroid. The primary end point was change in physician-scored disease using the SCORing Atopic Dermatitis (SCORAD) index, and secondary end points included caregiver assessment of disease severity, quality of life indices, bacterial colonization, and skin hydration status. Analysis of efficacy was per intent to treat with all patients who were randomized.

Of the population screened, two-thirds met the inclusion criteria, and only 5% were lost to follow-up. Twice-daily soak and seal decreased severity index by 21.2 (95% CI, 14.9–27.6, P < .0001) compared with twice-weekly bathing (greater than the minimal clinically important difference of 8.7). Fifty-eight percent of children receiving the wet method had a greater than 30% physician-assessed SCORAD improvement; however, a subset of patients (15%) did achieve a greater response with the “dry method.” Parent-assessed severity also improved significantly for the wet method compared with the dry method (P = .0052). No significant differences in quality of life indices, skin hydration status, S aureus relative colonization density, or desonide usage were observed.

Twice-daily soak-and-seal bathing is an effective strategy for moderate-to-severe pediatric AD.

AD impacts up to a third of all children, and this study adds clarity to the discussion of how frequently these children should bathe to improve disease course. The authors’ takeaway is clear: bathing more frequently provides objective improvement in moderate-severe pediatric AD, and these effects are also recognized by caregivers. While therapy needs to be tailored to individual context, hydration is key and more frequent “soak-and-seal” is a cost-effective strategy.