Weekly versus daily bathing for people with eczema: results of the eczema bathing online randomised controlled trial
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Background
Questions about washing are a high priority for people with eczema (syn. atopic dermatitis, atopic
eczema) but are rarely the focus of randomised controlled trials (RCTs).
Objectives
To assess the impact of weekly bathing compared to daily bathing in people with eczema in the first
of a series of eczema citizen science online trials in the United Kingdom.
Methods
Pragmatic, two-arm, parallel-group superiority RCT. People with self-reported eczema aged ≥1 were
eligible, excluding those with very mild eczema (Patient Orientated Eczema Measure (POEM) score ≤
2). Participants were allocated (1:1) using minimisation, balancing on eczema severity (POEM), age
and usual method of bathing, to either the weekly bathing group (bath or shower once or twice a
week) or the daily bathing group (≥6 times a week) for 4 weeks. Participants were not blinded to
their allocation. Primary outcome was participant reported eczema symptoms collected weekly over
four weeks using POEM (range 0 to 28, higher scores more severe).
Results
438 people with eczema (108 aged <16 years) were randomised between 29th January and 8th July
2024: 218 to daily bathing and 220 to weekly bathing. The primary analysis included 195 participants
(89%) allocated to daily bathing and 193 (88%) to weekly bathing who completed at least one follow up questionnaire. Mean POEM scores at baseline, 1, 2, 3 and 4 weeks, were 14.5 [standard deviation
5.7], 11.7 [5.9], 12.2 [5.9], 11.7 [6.7] and 11.6 [6.5], respectively, in the daily bathing group, and 14.9
[6.3], 12.1 [6.8], 11.3 [6.7], 10.5 [7.0] and 10.6 [7.2] in the weekly bathing group. The adjusted
difference in mean POEM score over 4 weeks for weekly versus daily bathing was -0.4 (95%
confidence interval -1.3 to 0.4, p = 0.30). Process evaluation data highlighted participants’
experiences of making changes to bathing routines, including barriers to following the allocated
routine. No serious unintended effects or harms were reported.
Conclusions
The trial found no evidence of a difference in eczema symptoms between bathing or showering
weekly compared to daily. These results are helpful for people with eczema, giving them the freedom
to choose what suits them best.
Questions about washing are a high priority for people with eczema (syn. atopic dermatitis, atopic
eczema) but are rarely the focus of randomised controlled trials (RCTs).
Objectives
To assess the impact of weekly bathing compared to daily bathing in people with eczema in the first
of a series of eczema citizen science online trials in the United Kingdom.
Methods
Pragmatic, two-arm, parallel-group superiority RCT. People with self-reported eczema aged ≥1 were
eligible, excluding those with very mild eczema (Patient Orientated Eczema Measure (POEM) score ≤
2). Participants were allocated (1:1) using minimisation, balancing on eczema severity (POEM), age
and usual method of bathing, to either the weekly bathing group (bath or shower once or twice a
week) or the daily bathing group (≥6 times a week) for 4 weeks. Participants were not blinded to
their allocation. Primary outcome was participant reported eczema symptoms collected weekly over
four weeks using POEM (range 0 to 28, higher scores more severe).
Results
438 people with eczema (108 aged <16 years) were randomised between 29th January and 8th July
2024: 218 to daily bathing and 220 to weekly bathing. The primary analysis included 195 participants
(89%) allocated to daily bathing and 193 (88%) to weekly bathing who completed at least one follow up questionnaire. Mean POEM scores at baseline, 1, 2, 3 and 4 weeks, were 14.5 [standard deviation
5.7], 11.7 [5.9], 12.2 [5.9], 11.7 [6.7] and 11.6 [6.5], respectively, in the daily bathing group, and 14.9
[6.3], 12.1 [6.8], 11.3 [6.7], 10.5 [7.0] and 10.6 [7.2] in the weekly bathing group. The adjusted
difference in mean POEM score over 4 weeks for weekly versus daily bathing was -0.4 (95%
confidence interval -1.3 to 0.4, p = 0.30). Process evaluation data highlighted participants’
experiences of making changes to bathing routines, including barriers to following the allocated
routine. No serious unintended effects or harms were reported.
Conclusions
The trial found no evidence of a difference in eczema symptoms between bathing or showering
weekly compared to daily. These results are helpful for people with eczema, giving them the freedom
to choose what suits them best.
Date Issued
2026-03-01
Date Acceptance
2025-10-21
Citation
British Journal of Dermatology, 2026, 194 (3), pp.450-460
ISSN
0007-0963
Publisher
Oxford University Press
Start Page
450
End Page
460
Journal / Book Title
British Journal of Dermatology
Volume
194
Issue
3
Copyright Statement
© The Author(s) 2025. Published by Oxford University Press on behalf of British Association of Dermatologists. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Publication Status
Published
Article Number
ljaf417
Date Publish Online
2025-11-10