From Heather Brannon, MD,
Your Guide to Skin & Beauty.
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About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

It is important for people with eczema and their loved ones to understand how to take care of their skin because using the wrong soap or moisturizer can cause flare-ups that are itchy or painful. On the other hand, using the correct soap or moisturizer can calm down inflamed skin or prevent flare-ups.

Eczema - "Leaky Skin"

In general people who have eczema have "leaky skin," meaning the barrier function of their skin does not work well. Practically this means:

• Anything that goes on the skin soaks in to the deeper layers that activate the immune system.
• The skin loses water and the natural oils that normally moisturize it and keep it supple.

These changes cause the skin to be drier than normal skin and more sensitive to anything that comes in contact with the skin.

Water - Good or Bad?

You would think that putting water on the skin would moisturize it more, but the opposite is true. Plain water that comes in contact with the skin evaporates and takes with it many of the skin's natural oils called natural moisturizing factor (NMF). The more often the skin has contact with water, the drier it gets unless those natural oils are replaced. But your skin has to come in contact with water when you bathe and wash your hands. Is it more important to bathe to clean the skin or avoid water to keep the skin moisturized? The following are some guidelines to follow when it comes to water contact:

• Water temperature should be tepid -- hotter water takes more oils away than cooler water.
• The length of contact should be short -- no long, hot showers especially if you have a flare-up.
• Using antibacterial gels for hand-washing does not cause the skin to dry out because the alcohol does not bind to NMF taking them away when it evaporates.
• When drying off, pat the skin dry with a towel until the skin is not dripping -- do not rub the skin vigorously.
• Use a good moisturizer on the skin immediately after any contact with water.

Soaps for Eczema

The effect of soap on the skin is not good for people with eczema. Most soaps, especially bar soaps, dry the skin out. Liquid cleansers are much less damaging to the skin than bar soaps. Using an emollient-rich liquid cleanser that leaves a moisturizer on the skin when the soap is washed off is the best choice for people with eczema. For specific product recommendations, see the best soaps for eczema.

Moisturizers for Eczema

Not only is it important to use a moisturizer often (up to three times a day), it is important to use one that does not contain perfumes, fragrances or essential oils, because these are all potentially very irritating to eczematous skin.

Moisturizer Recommendations

I don't have one moisturizer I would recommend over the others -- they all have pros and cons. The following are different types of moisturizers to consider:

• The moisturizers for scaly eczema would be a good choice if you have a lot of flaking without a flare because they can sting if applied to open areas on the skin.
• The emollient moisturizers are a low-cost option, especially if you are in the middle of a flare-up, because they are not irritating.
• The new ceramide moisturizers help the skin heal faster during a flare, but the only low-cost option does not have published data proving it is effective. If you can afford them, these moisturizers would be a great choice with or without a flare.

  _Sources:

  Boguniewicz, Mark. "Atopic Dermatitis: Beyond the Itch that Rashes." Immunology and Allergy Clinics of North America 25(2005): 333-51.

  Chamlin, Sarah, et al. "Ceramide-dominant barrier repair lipids alleviate childhood atopic dermatitis: Changes in barrier function provide a sensitive indicator of disease activity." Journal of the American Academy of Dermatology 47(2002): 198-208.

  Choi, Myeong Jun, and Howard Maibach. "Role of Ceramides in Barrier Function of Healthy and Diseased Skin." American Journal of Clinical Dermatology 6(2005): 215-22.

  Coderch L, et al. "Efficacy of stratum corneum lipid supplementation on human skin." Contact Dermatitis. 3(2002):139-46.

  Halvarsson, K, and M. Loden. "Increasing quality of life by improving the quality of skin in patients with atopic dermatitis." International Journal of Cosmetic Science 29(2007): 69-83.

  Hanifin, Jon, et al. "Guidelines of Care for Atopic Dermatitis." Journal of the American Academy of Dermatology 50(2004): 391-404.

  Simpson, Eric, and Jon Hanifin. "Atopic Dermatitis." The Medical Clinics of North America 90(2006): 149-167.