Water and Bathing

A compromised (“leaky”) skin barrier is one of the main features of atopic dermatitis, and this means that lots of water can leak out of the skin, leaving it dry and irritated. It makes sense then, that the ancient practices of spa therapy and bath therapy (balneotherapy) are important to consider for treating eczema.

Balneotherapy usually means soaking in a mineral water bath or pool, often in a warm, sunny climate such as the Dead Sea in the Middle East. It is important to add that these experiences are often far away from the stress of everyday life, and this also probably plays a role in the healing.

A randomized trial of 104 children with mild to moderate eczema received either balenotherapy once daily for two weeks or topical steroid during that time. Both groups had significant improvement in eczema, although the steroid group did have a significantly larger effect. However, 4 months later the balneotherapy group had fewer and shorter flares than the steroid group (Farina, 2011). Other studies also demonstrate similar improvement.

While encouraging, a spa vacation at the Dead Sea or in southern France is not possible for most patients with AD, and many have tried to recreate these conditions. Using light therapy with narrow band UVB plus soaking in a mineral bath, a study found that the combination was more effective than light therapy alone (Heinlin, 2011).

A German study compared using a bath with a Dead Sea minerals compared to a simple salt water bath and reported better effect in the Dead Sea mineral group after 4 weeks (Zimmermann, 1994).

Strangly, despite these studies suggesting improvement with mineral-rich water, there are other studies and reports connecting hard water (another name for mineral-rich water) with the worsening of eczema.

A study was done to test the effect of a water softener on atopic dermatitis and found that at 12 weeks, there was no detectable difference between the groups (Thomas, 2011).

The powerful and dramatic effect of going to the Dead Sea or to mineral springs on atopic dermatitis is probably due to a combination of the sunlight, the relaxed atmosphere, and the mineral water itself, rather than to just the healing properties of the water. For those that can afford to go, there is the promise of great temporary relief with perhaps more mild disease even after returning home. For those that cannot make the trek, phototherapy and good bathing practices can probably mimic a large part of the effect that is never more than a quick car ride away.


1. Farina, S., Gisondi, P., Zanoni, M., Pace, M., Rizzoli, L., Baldo, E., Girolomoni, G.: Balneotherapy for atopic dermatitis in children at Comano spa in Trentino, Italy. The Journal of dermatological treatment. 22, 366–71 (2011).

2. Heinlin, J., Schiffner-Rohe, J., Schiffner, R., Einsele-Krämer, B., Landthaler, M., Klein, A., Zeman, F., Stolz, W., Karrer, S.: A first prospective randomized controlled trial on the efficacy and safety of synchronous balneophototherapy vs. narrow-band UVB monotherapy for atopic dermatitis. Journal of the European Academy of Dermatology and Venereology : JEADV. 25, 765–73 (2011).

3. Zimmermann, J., Utermann, S.: [Photo-brine therapy in patients with psoriasis and neurodermatitis atopica]. Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete. 45, 849–53 (1994).

4. Thomas, K.S., Dean, T., O’Leary, C., Sach, T.H., Koller, K., Frost, A., Williams, H.C.: A randomised controlled trial of ion-exchange water softeners for the treatment of eczema in children. PLoS medicine. 8, e1000395 (2011).