Frequent Versus Infrequent Bathing in Pediatric Atopic Dermatitis

There remain only a few studies that evaluate bathing frequency in pediatric atopic dermatitis (AD). Parents of children with AD often receive conflicting information, causing frustration and confusion.

The present study evaluated the efficacy of twice-daily soaking baths, followed by immediate application of an occlusive moisturizer (i.e., soak-and-seal [SS]), versus twice-weekly SS baths, in the acute management of pediatric AD.

It compared frequent versus infrequent SS baths in children six months to 11 years of age with moderate-to-severe AD. The study randomized the children equally into two groups: group 1 underwent twice-weekly SS baths, for 10 minutes or less, over two weeks ("dry method" [DM]), followed by twice-daily SS baths, for 15 to 20 minutes, over two weeks ("wet method" [WM]). While Group 2 did the inverse. Patients received the same moisturizer, cleanser, and low-potency topical corticosteroid (TCS). 

The study looked for AD severity evaluated using the SCORing Atopic Dermatitis (SCORAD) index. It also assessed Caregiver assessment of AD severity (Atopic Dermatitis Quickscore [ADQ]), quality of life, Staphylococcal aureus colonization, skin hydration, moisturizer, and TCS usage.

The study observed-

• The inclusion of 42 children, among which 40 completed the study.
• Decrease in SCORAD by 21.2 with WM compared with DM. 
• A greater than 30% SCORAD improvement for WM versus DM in secondary analysis. 
• SCORAD correlated with ADQ.
• significant improvement in ADQ, with WM decreasing ADQ by 5.8.
• Non-significant results in other secondary endpoints.

This study shows the superiority of WM oven DM in improving disease severity in moderate-to-severe pediatric AD as an acute treatment intervention.

Cardona ID, Kempe EE, Lary C, et al. Frequent Versus Infrequent Bathing in Pediatric Atopic Dermatitis: A Randomized Clinical Trial. The Journal of Allergy and Clinical Immunology: In Practice. 2020;8(3):1014-1021. https://doi.org/10.1016/j.jaip.2019.10.042.