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Salt Water Baths and Eczema

The Evidence

There is no high quality evidence as yet showing that salt water baths are beneficial for atopic eczema sufferers. There is one small clinical trial from Japan which compared two different types of salt water, but we are aware of none that compares salt water versus ordinary water. However there is a lot of anecdotal evidence suggesting that salt water baths may be helpful in clearing up eczema, especially if it is oozing a lot or where secondary infection is common. A number of UK dermatologists recommend regular salt baths to their patients with atopic eczema as part of their treatment plan. It is certainly something that our team at QMC have witnessed some benefit from.

It is also a very common experience in our clinic for parents to tell us that their child's eczema improved when they swam in the sea on holiday. Although this could easily be due to the change of climate and diet etc, the swimming in the sea seems to be a particular feature that is highlighted in these conversations. Sea water is a weak antiseptic and may well have a role in reducing the secondary infection which so commonly occurs in atopic eczema. It is possible that the salt water also helps to draw out excess fluid that has accumulated in to little water blisters in the skin, as well as helping to heal any minor cuts and scratches.

We would not recommend salt water baths as a first line treatment in atopic eczema. But if you are struggling to control your child atopic eczema it may be worth trying, especially if infections are a common problem. We do not really know how strong the salt needs to be in the absence of a controlled trial (which we hope to do in the near future), but we would recommend that you try and mimic the concentration of sea water as closely as possible.

Sea salt can be quite expensive and it is important that you shop around to get the best bulk buy as you will need to use quite a lot of salt in order to get a decent concentration in the bath. It is unclear whether daily bathing or whether weekly bathing is the best and perhaps as a compromise a salt water bath twice a week could be managed by most who wish to undertake this approach to treatment. It should be emphasised that the salt water bathing is only part of the whole treatment of atopic eczema and that other treatments such as short bursts of topical steroid creams prescribed by your doctor, regular and liberal use of moisturisers and avoidance of soaps etc should be continued.

Making up the Salt Solution

You will need to use around a 20 fluid ounce jug of sea salt per 3 gallon bucket of water in order to achieve a similar concentration to sea water. It is usually easier to pour the salt into the bottom of the bucket and dissolve it in a little warm water before pouring it into the bath. Around 3 buckets will usually be enough for your child to soak in.

If your child has lots of broken skin the salt water (or indeed any type of water) can cause temporary stinging. It is important that the broken skin is first treated with steroid creams and moisturisers before introducing the bathing. If your child hates the bathing process then there is little point in persisting with it as you will simply create resentment and difficulties for applying treatment.

Summary of Key Points

• There is considerable anecdotal evidence that salt water baths may help some children with atopic eczema.
• We do not know how strong the salt water solution has to be nor how frequently the bath should be done.
• Common sense would suggest that the concentration should be similar to sea water and that bathing twice weekly or even daily during an infected episode of eczema may be beneficial.
• It is important to use sea salt and not any other types of chemical salts and to ensure that the salt is fully dissolved in warm water before pouring it into the bath. Nottingham Eczema Team 2000