Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
National Skin Centre, Singapore, Singapore.
Arch Dermatol Res. 2021 Nov;313(9):729-735. doi: 10.1007/s00403-020-02164-0. Epub 2020 Nov 16.
The optimal frequency of water bathing/showering in atopic dermatitis (AD) is unknown. We sought to determine the efficacy of different bathing/showering frequencies at improving AD severity. A systematic review and meta-analysis was performed of studies evaluating the clinical efficacy of bathing/showering regimen in AD. MEDLINE, EMBASE, SCOPUS, LILACS, Cochrane, China National Knowledge Infrastructure, Taiwan electronic periodical services and CiNii were searched. Two authors independently performed title/abstract and full-text review and data extraction. All 13 included studies were prospective and demonstrated numerically reduced AD severity in patients treated with a water bathing/showering regimen in ≥ 1 time-point compared with baseline. In random-effects regression models, baths/showers ≥ 7 vs. < 7 times per week were not associated with significant differences of Cohen's D scores for eczema area and severity index (n = 5 studies; least-square means: 1.34 vs. 0.90; P = 0.45; I = 91.8), Scoring AD (n = 5 studies; 0.73 vs. 0.41; P = 0.13; I = 97.4) or body surface area (n = 4 studies; 0.45 vs. 0.28; P = 0.17; I = 93.4). Similar results were observed in sensitivity analyses by study design, quality, use of emollients, and use of topical corticosteroids. No publication bias was detected by Egger regression (P ≥ 0.26) or Begg rank (P ≥ 0.19) tests. Three studies were included in the qualitative analysis, which found that bathing/showering ≥ 7 resulted in significant improvement of Investigator Global Assessments, extent of skin lesions and itch caused by AD. In conclusion, the optimal frequency of water bathing/showering in AD remains unclear. Daily showers/baths were not associated with worse severity, and should be permitted in AD. Larger scale, well-designed RCT are still needed to determine the optimal bathing parameters.
在特应性皮炎（AD）中，沐浴/洗澡的最佳频率尚不清楚。我们旨在确定不同沐浴/洗澡频率对改善 AD 严重程度的疗效。对评估沐浴/洗澡方案在 AD 中的临床疗效的研究进行了系统评价和荟萃分析。检索了 MEDLINE、EMBASE、SCOPUS、LILACS、Cochrane、中国国家知识基础设施、台湾电子期刊服务和 CiNii。两位作者独立进行了标题/摘要和全文审查以及数据提取。所有 13 项纳入的研究均为前瞻性研究，结果表明，与基线相比，≥1 次/周水疗的患者 AD 严重程度数值降低。在随机效应回归模型中，与每周沐浴/洗澡<7 次相比，≥7 次与湿疹面积和严重指数（n=5 项研究；最小二乘均值：1.34 与 0.90；P=0.45；I=91.8）、SCORing AD（n=5 项研究；0.73 与 0.41；P=0.13；I=97.4）或体表面积（n=4 项研究；0.45 与 0.28；P=0.17；I=93.4）的 Cohen's D 评分无显著差异。根据研究设计、质量、保湿剂使用和局部皮质类固醇使用进行敏感性分析，观察到类似的结果。Egger 回归（P≥0.26）或 Begg 秩（P≥0.19）检验未检测到发表偏倚。三项研究纳入定性分析，结果发现，≥7 次沐浴/洗澡可显著改善研究者整体评估、AD 引起的皮损程度和瘙痒。总之，AD 患者的最佳沐浴频率尚不清楚。每日淋浴/洗澡不会导致病情恶化，在 AD 中应允许使用。仍需要更大规模、精心设计的 RCT 来确定最佳沐浴参数。
